Pediatric Intracranial Infections Requiring Neurosurgery: A German Multicenter Analysis of 10-Year Trends Pre-COVID-19 and Post-COVID-19.

BACKGROUND AND

OBJECTIVES

Intracranial infection in children is a rare but life-threatening condition that requires immediate neurosurgical care. The impact of the COVID-19 pandemic on incidence and outcome is unclear.

METHODS

This study is a multicenter retrospective analysis of children who underwent neurosurgical treatment of intracranial infections (epidural abscess, subdural empyema, cerebral abscess, ventriculitis, and meningitis) between January 2014 and October 2024. Comparison of children with intracranial infections and neurosurgical intervention stratified by pre and postpandemic.

RESULTS

The annual incidence of pediatric intracranial infections requiring neurosurgery increased significantly from 5.6 cases (95% CI: 4.0-7.5) prepandemic to 14.4 cases (95% CI: 11.2-18.0) postpandemic, with an incidence risk ratio (IRR) of 2.6 (95% CI: 1.8-3.8; P < .0001). Causative were the observed sinusitis-associated cases, with absolute numbers rising from 13 prepandemic to 31 postpandemic. The annual incidence increased from 1.81 cases (95% CI: 0.99-2.97) to 6.45 cases (95% CI: 4.44-9.00), yielding an IRR of 3.6 (95% CI: 1.9-7.1; P = .0001). For otitis-related cases, absolute counts surged from 6 to 19, accompanied by an incidence increase from 0.83 (95% CI: 0.33-1.69) to 3.95 (95% CI: 2.43-6.01), with an IRR of 4.7 (95% CI: 2.0-13.0; P = .0009). However, functional outcomes assessed by the pediatric modified Rankin Scale showed no statistically significant differences between pre- and postpandemic cohorts in the Wilcoxon-Mann-Whitney test, both at discharge ( P = .388) and at 3-month follow-up ( P = .927).

CONCLUSION

Our study demonstrates a significant increase in the incidence of intracranial infections requiring neurosurgical treatment in children after the pandemic, with a 2.4-fold higher IRR compared with the prepandemic period. The postpandemic group had a significantly higher incidence of underlying complicated otitis and sinusitis.