The role of neuroendoscopy in treatment of pediatric brain abscesses: case series and systematic review of the literature.

Treatment of brain abscesses in children requires a multimodal approach, consisting of neurosurgical evacuation and intravenous antibiotics. Endoscopic aspiration has been used for extensive removal of the purulent collection, but few pediatric cases have been described in literature. We report the management of endoscopically treated brain abscesses in children in our department and provide a systematic review of the literature. We retrospectively collected data on a series of children with intracerebral abscesses treated endoscopically. The literature search was performed and studies between 1979 and 2024 were included. Seven cases were retrieved, 3 were neonates and 4 were 6–14 years old. Neuronavigationwas used to plan the access point and trajectory. The endoscopic approach under a direct vision with the use of an endoscopic ultrasonic aspirator was chosen to ensure the maximum safe resection and thus reduce the possibility of recurrence. All patients were also treated with intravenous antibiotics. Surgeries were uneventful and without recurrence. Six papers (9 patients) reporting endoscopic evacuation of intracranial abscesses were identified in the literature. The age of the patients ranged between 4 months and 11 years. In none of the cases described the ultrasonic aspirator was used for abscess drainage. Endoscopic aspiration is an effective method for treatment of intracranial abscesses in children. Neuronavigation is highly recommended to identify the optimal entry point, especially for deep-seated lesions. The ultrasonic aspirator plays a key role in efficiently removing the collections. This method is particularly important for children, where minimizing invasiveness is crucial. Further studies are needed to identify the optimal duration of the intravenous antibiotic treatment after neuroendoscopic surgery, whether it can be shorter than that of the standard intervention.