Management Options of Brain Abscess in Children with Cyanotic Heart Disease [CHD], Craniotomy vs Burr hole in a Developing Country

ABSTRACT

The aim of our study was to compare the advantages and disadvantages of burr hole and craniotomy methods in management of brain abscess in children secondary to cyanotic congenital heart disease [CHD]. The parameters used to compare these two methods were outcome of the treatment, improvement of Glasgow coma score, CT appearance of abscess andre-operation. Retrospective study was conducted over 6 year's period. A total of thirty three [33] paediatric patients were included in this descriptive study which was carried out in the Neurosurgery Department of Foundation University Medical College Rawalpindi, Pakistan from June 2003 to May 2009. Patients having the following criteria were selected for burr hole procedure Intracranial abscess in patients of congenital heart disease, no previous surgical intervention, Patient's history and CT brain films available. Following patients were excluded from the study; postoperative, post traumatic and fungal abscess, age more than 15 years old and abscess less than 25mm Patients having low risk of anaesthesia and absence of above mentioned risk factors were selected for craniotomy and excision. Our study results showed that patients who underwent the burr hole aspiration of abscess had a decreased mortality, shorter hospital stay, significant improved progress in neurological and radiological status as compared to craniotomy and excision group. Our study results suggested that burr hole aspiration is more efficient procedure as compared to craniotomy in terms of surgical intervention and postoperative outcome in a selected group of brain abscess in patients with CHD. It is also a cost effective procedure