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Brain and Spinal Abscess

What is an abscess?

An abscess is a collection of pus caused by infection. In the central nervous system, an abscess can occur:

  • In brain tissue or around the lining of the brain
  • In the outer covering of the spinal cord (the epidural space)
  • Inside the sac that contains the spinal cord
  • On the bones of the spine (vertebrae)

Who gets a brain or spinal cord abscess?

Brain and spinal abscesses are rare in children. A brain abscess is usually caused by bacteria from an ear, sinus, mouth or tooth infection.

It can come from an infection in the central nervous system, such as meningitis. It can also occur in a child with cyanotic heart disease.

Spinal abscesses usually spread via the blood.

What is your experience with brain and spinal cord abscesses?

Children rarely get abscesses of the brain or spinal cord. However, when they do, doctors from our region — Washington, Montana, Idaho and Alaska — refer them to our neurosurgery team. Not all of these children need surgery.

Our neurosurgeons operate on five to 10 children a year for brain or spinal abscesses.

What surgery or procedure do you use to treat a brain or spinal abscess?

We treat all brain and spinal cord abscesses with very strong antibiotics (medicine that kills bacteria). For some children, this therapy is enough and they do not need surgery.

Brain abscess

When surgery is necessary, it is most often because the abscess is large and creating pressure inside the head that causes symptoms.

With the help of surgery, we can find out what kind of bacteria is causing an abscess and choose the best antibiotic treatment.

We have a few options for operating on a brain abscess:

Burr hole

We drill a small hole in the child’s skull and drain the pus.

Craniotomy

If a surgeon needs to get directly to the patient’s brain, he does a craniotomy. During a craniotomy the neurosurgeon removes a part of the skull (cranium) in order to reach a part of the brain needing surgery.

First the surgeon cuts and removes a piece of bone. He then cuts the tough membrane called the dura mater — the membrane that protects the brain. Using highly technical equipment, he skillfully drains the pus.

The neurosurgeon then closes the dura mater and closes up the skull using the same piece of bone he removed, if possible. Sometimes we use hardware such as micro plates, screws and wires to close the child’s skull.

Spinal abscesses

Draining a spinal abscess usually requires surgery to relieve pressure on the spinal cord.

When a child arrives at Children’s with a spinal abscess he may have symptoms such as leg weakness, trouble walking, numbness, etc. This means he is losing neurological function and may require immediate surgery.