Attempt at Ultrasound-Guided Aspiration of Intracranial Abscess in Children in our Environment with its Peculiarity

Abstract

Background: Intracranial abscesses are rare and have grave consequences if not treated early. There are several surgical treatment modalities, including ultrasound-guided aspiration, which has been proven to be a quick, safe and cost-effective means of evacuation. This may be carried out through a burrhole or through a pre-existing cranial defect such as the anterior fontanelle.

Aims and Objectives: To demonstrate the benefit of ultrasound-guided aspiration of intracranial abscesses in infants and older children.

Materials and Methods: Five children (four infants aged 2 to10months, all of whom were females, and a 14-year old male) with various intracranial abscesses had surgical evacuation after detailed clinical and radiological evaluation. One had multiple burrholes for evacuation of multiple abscesses, but did not survive; two had initial burrhole evacuation followed by ultrasound-guided evacuation for recurrent or residual abscess. The remaining two had ultrasound-guided evacuation for both the initial evacuation and the follow-up procedure for evacuation of recurrent or residual abscesses.

Results: One of the infants had multiple burrholes for drainage of 600mls of pus as the first and only procedure. She died after 48hours. The other four had two-staged procedures involving either burrhole or ultrasound-guided evacuation as initial procedure, followed by ultrasound-guided evacuation alone as second procedure for recurrent or residual abscesses. The latter improved and were discharged without further neurological deficits.

Conclusion: Ultrasound-guided aspiration of intracranial abscesses under local anesthesia is a quick, safe, and cost-effective means of evacuating multiple abscesses in infants and older children. This is useful in settings with limited resources especially for patients who may be too ill for general anaesthesia.

Keywords: Intracranial Abscess; Ultrasound guidance; Cranial defect: Anterior fontanelle; Burrhole.