Surgical Complications of Purulent Meningitis in Infants

Abstract

Nine infants of purulent meningitis with complications requiring surgery have been treated in our clinic during the period from 1970 to 1972. These complications consisted of 7 cases of hydrocephalus, 1 brain abscess and 1 subdural abscess. For hydrocephalus, a ventriculo-peritoneal shunt was carried out following observation for at least two months after CSF became aseptic. In spite of such cautious treatment, most of the patients required frequent revision of shunts due to obstruction or infection of shunt valves. Long-lasting high concentration of protein and/or pleocytosis in CSF impedes the potency of shunt valves. In order to overcome such obstacles, we employed either frequent removal of ventricular fluid by means of a subcutaneously placed Ommaya reservoir or lavage of the ventricles so as to dilute the concentrated CSF. Both methods produced successful results. The patient with brain abscess died after surgery for hydrocephalus, while the patient with subdural abscess recovered completely after drainage of the abscess cavity. In our experience, surgical intervention to treat these complications of purulent meningitis yield good results unless the patient has had neurological deficits preoperatively. Therefore, surgical treatment must be performed as early as possible, well in advance of development of irreparable brain damage. © 1974, The Japanese Society of Child Neurology. All rights reserved.