DOI: 10.1097/mao.0000000000005100 ISSN: 1531-7129

Infection in Pediatric Auditory Brainstem Implant: A Case Study and Scoping Review

Leena Asfour, Aparna Govindan, John M. Reynolds, Sandra Velandia, Fred Telischi, Carolina Benjamin, Christine T. Dinh
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Objective:

Safety and efficacy of pediatric auditory brainstem implants (ABI) are well established. Commonly reported complications include cerebrospinal fluid (CSF) leak and pseudomeningocele. Infection is rare but potentially serious due to intracranial location of the device. Data on pediatric ABI infections remain limited. We report a case of pediatric ABI infection and perform a scoping review of the literature.

Databases reviewed:

PubMed, Web of Science, Scopus, and the Cochrane Library.

Methods:

The patient’s medical record was reviewed for clinical course and outcomes. A scoping review was conducted to summarize findings of studies reporting pediatric ABI-related infections.

Results:

A 12-year-old female with NF2 -related schwannomatosis and bilateral vestibular schwannomas underwent urgent right tumor resection with ABI placement. She represented on postoperative day 13 with meningitis and collection surrounding the device. Surgical exploration revealed purulence involving the ABI pocket and paddle. Device preservation was achieved with washout, fat graft replacement, vancomycin powder application, and prolonged antibiotic therapy. For the scoping review, 961 studies were screened and 9 included, identifying 12 pediatric ABI infections. Five were managed with antibiotics alone, 3 required additional CSF diversion, and 4 necessitated surgical intervention.

Conclusion:

Pediatric ABI infections are uncommon but potentially life-threatening, necessitating prompt recognition and aggressive management. Our scoping review revealed that pediatric ABI infections have been managed with antibiotics with or without surgical intervention, and infection-related ABI explantation in pediatric patients has not been reported. In our case, device preservation was achieved with washout, fat graft replacement, and intravenous and intrathecal antibiotics.

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