Cerrahi tedavi uygulanan pediyatrik intrakraniyal apse ve ampiyemler: Tek merkezli bir deneyimden özellikler ve sonuçlar

Öz

Amaç: Pediatrik intrakraniyal abse ve ampiyemler, mortalite/morbidite riski taşıyan nöroşirürjik acillerdendir. Bu çalışmada, cerrahi olarak tedavi edilen pediatrik intrakraniyal süpüratif enfeksiyon olgularının klinik, radyolojik ve mikrobiyolojik özellikleri ile cerrahi yönetim stratejileri ve fonksiyonel sonlanımları değerlendirilmiş; prognozu belirleyen faktörler analiz edilmiştir. Gereç ve Yöntemler: Kasım 2022–2025 arasında intrakraniyal abse veya ampiyem nedeniyle cerrahi uygulanan 21 pediatrik hasta retrospektif incelendi. Demografik, klinik, radyolojik, laboratuvar, mikrobiyolojik ve tedaviye ait veriler analiz edildi. Sonlanım 6. aydaki Glasgow Sonuç Ölçeği (GOS) ile değerlendirildi ve iyi (GOS 5) ve kötü (GOS ≤ 4) olarak ikili sınıflandırıldı. Nörolojik sekel ayrı bir sonlanım ölçütü olarak ele alındı. İstatistiksel analizlerde parametrik olmayan yöntemler kullanıldı. Bulgular: En sık tanı subdural ampiyemdi (%66,7) ve büyük çoğunluğu supratentoryaldi (%95,2). Medyan yaş 87 aydı, hastaların %71,4’ü erkekti. Olguların %95,2’sine kraniyotomi ile drenaj uygulandı. Tedavi sonrası C-reaktif protein ve beyaz küre değerlerinde anlamlı düşüş saptandı (her ikisi için p<0,001). Altı aylık takipte %66,7’sinde iyi fonksiyonel sonlanım görüldü. Başvuru anında GKS <15 olması kötü sonlanım ile güçlü şekilde ilişkiliydi (%100 vs. %6,7; p<0,001). Buna karşın orta hat şifti (p=0,638), beyin ödemi (p=1,000), enfeksiyon yaygınlığı (p=0,659), nöbet varlığı (p=0,061) ve etiyoloji (p=1,000) ile sonlanım arasında anlamlı ilişki saptanmadı. Nörolojik sekel oranı %23,8 idi. Mortalite ve enfeksiyon nüksü izlenmedi. Sonuç: Pediatrik intrakraniyal enfeksiyonlarda uygun cerrahi ve antibiyoterapi ile başarılı sonuçlar mümkündür. Başvuru sırasındaki nörolojik durum, fonksiyonel sonlanımın en önemli belirleyicisidir; izole radyolojik kitle etkisi bulgularının ise prognostik değeri sınırlıdır.

Anahtar Kelimeler

• Beyin apsesi
• subdural ampiyem
• epidural apse
• çocuk

Surgically treated pediatric intracranial abscesses and empyemas: Characteristics and outcomes from a single-center experience

Öz

Aim: Pediatric intracranial abscesses and empyemas are neurosurgical emergencies associated with significant morbidity and mortality. This study evaluated the clinical, radiological, and microbiological characteristics of surgically treated pediatric intracranial suppurative infections, as well as surgical management strategies, functional outcomes, and prognostic factors. Material and Methods: Twenty-one pediatric patients who underwent surgery for intracranial abscess or empyema between November 2022 and 2025 were retrospectively reviewed. Demographic, clinical, radiological, laboratory, microbiological, and treatment-related data were analysed. Outcomes were assessed using the Glasgow Outcome Scale (GOS) at 6 months and classified as favourable (GOS 5) or unfavourable (GOS ≤ 4). Neurological sequelae were evaluated separately. Non-parametric statistical methods were applied. Results: Subdural empyema was the most common diagnosis (66.7%), and most lesions were supratentorial (95.2%). The median age was 87 months, and 71.4% of patients were male. Craniotomy with drainage was performed in 95.2% of cases. Post-treatment C-reactive protein and white blood cell levels significantly decreased (p<0.001). At 6-month follow-up, 66.7% of patients achieved favourable functional outcomes. A Glasgow Coma Scale score <15 at presentation was strongly associated with unfavourable outcomes (100% vs. 6.7%; p<0.001). No significant association was found between outcomes and midline shift, cerebral edema, infection extent, seizure presence, or etiology. Neurological sequela occurred in 23.8% of patients, and no mortality or recurrence was observed. Conclusion: Successful outcomes can be achieved in pediatric intracranial suppurative infections with appropriate surgical drainage and antibiotic therapy. Neurological status at presentation is the strongest determinant of functional outcome, whereas isolated radiological mass-effect findings have limited prognostic value.

Anahtar Kelimeler

• Brain abscess
• subdural empyema
• epidural abscess
• child

Kaynakça

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