Cerebellar Abscess: The Impact of Computed Tomographic Scanning

Abstract

Thirty-four cases of cerebellar abscess, diagnosed by computed tomographic (CT) scanning, were managed according to a standard protocol during a 4-year period. Triple high dosage intravenous antibiotics were used, open catheter drainage of the abscess was instituted, and external ventricular drainage was added if obvious hydrocephalus was present. Seventeen patients made a good recovery, and five remained minimally disabled. Ten patients died, and two were left severely disabled. A relationship between the level of consciousness on admission and final outcome was established. In addition, two particular CT scan features (viz. the presence of hydrocephalus and the stage of the abscess) were significant adverse prognostic factors.

Management of brain abscesses in children

“…The condition of neurologically intact patients can rapidly deteriorate to a comatose state due to obstructive hydrocephalus and/or mass effect on the brainstem. 2,12,42,103 A wide decompression of the posterior fossa has been advocated because of the precarious state of a cerebellar abscess in the small volume of the posterior fossa. 2,39 In 1973, Bhatia et al 8 reviewed 55 cases of brain abscesses, in which 11 were located in the posterior fossa.…”

Primary Excision of Pediatric Posterior Fossa Abscesses – Towards Zero Mortality?

“…Often regarded as treacherous lesions with an unpredictable course [10], the mortality stems from the space-occupying effect caused both by the lesion and by surrounding edema. Due to the relatively small volume of the posterior fossa, the effect of edema, which may be disproportionate to the size of the abscess in a large number of cases [2, 4], may be catastrophic. Wide decompression of the posterior fossa is therefore advisable in all cases of posterior fossa abscesses and in fact has been advocated in the past by Griffith [12].…”

“…Prospective studies with tapping [6]or open catheter drainage [2, 11]have shown a high mortality of 11.6% [11]to 29% [2], and a morbidity of 14% [11]to 21% [2]. …”

“…Various series have quoted a mortality rate between 11 and 41% for posterior fossa abscesses [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. In spite of early detection of such abscesses and advances in anesthetic techniques, the mortality rates have remained relatively constant [2, 4, 6].…”

“…In spite of early detection of such abscesses and advances in anesthetic techniques, the mortality rates have remained relatively constant [2, 4, 6]. Controversy still surrounds the optimum management of these abscesses, with a sizeable number of neurosurgeons preferring primary aspiration over primary excision as the treatment of choice.…”