The authors review the management of brain abscesses (BAbs) in 59 pediatric cases. The major surgical procedure used to treat them was repeated puncture and aspiration (51 cases, or 86.44%), excision (8 cases - 13.56%) being of secondary importance. The main etiology was metastatic lesions (24 cases - 40.68%), those due to cyanotic congenital heart disease being the most frequent. Single lesions dominated (41 cases - 69.49%). Gram-positive cocci were the main bacteria involved (31 cases, 52.5%). CT scan represented the main tool in the diagnosis and follow-up. Puncture and aspiration in BAbs led to a significant decrease in mortality (7 cases - 11.86%), and the incidence of seizures and neurological deficits was also reduced. Mortality was significantly correlated with the following factors: consciousness status, multiple BAbs location and hematogenous dissemination. There were recurrences in 11 cases (18.64%), all observed after aspiration procedures. The current concepts for complex management of BAbs, as reflected in recent literature data, are reviewed, with particular emphasis on the use of real-time CT or ultrasound-guided operative techniques.