A Review of Brain Abscess Surgical Treatment—78 Years: Aspiration versus Excision

Ratnaike, Thiloka; Das, Suparna; Gregson, Barbara; Mendelow, AD

doi:10.1016/j.wneu.2011.03.048

Cited by 97 publications

(80 citation statements)

References 11 publications

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“…The morbidity rates for craniotomy and resection, free-hand aspiration and image-guided aspiration were 8.1%, 2.7%, 3.7% (p=0.219). These findings are in agreement with other reports (13,19,28,30). Additionally, mortality was significantly higher in patients over the age of eighteen years.…”

Section: Outcomesupporting

confidence: 94%

“…The choice of surgical method changed with the introduction of CT. The number of brain abscess patients who were treated by aspiration increased over time (19). Aspiration, repeated as necessary, widely replaced attempts at complete excision.…”

Section: Surgical Methodsmentioning

confidence: 99%

“…The treatment of a brain abscess involves aspiration of the pus or excision of the abscess, followed by parenteral antibiotic therapy (21). In the last three decades, the diagnosis and outcome of surgical treatment of pyogenic brain abscesses have improved with the emergence of imaging technologies, image-guided stereotaxy, more effective antibiotics and the development of advanced techniques in detecting causative microorganisms (3,4,10,14,17,19).…”

Section: █ Introductionmentioning

confidence: 99%

“…The use of excision by craniotomy as a standard treatment has declined noticeably, and the preferred method is currently surgical aspiration (1,10,19). However, some authors concluded that craniotomy is the preferred surgical method for pBa (6,7,16,26).…”

Section: █ Introductionmentioning

confidence: 99%

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Surgery for pyogenic brain abscess over 30 years: evaluation of the roles of aspiration and craniotomy

Aras

Sabancı²,

İzgi³

et al. 2015

Turkish Neurosurgery

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AIM:To evaluate the roles of craniotomy and aspiration in the treatment of pyogenic brain abscess throughout 30 years of computerized tomography. MATERIAl and METhODS:A retrospective study of 224 patients who were surgically treated at Istanbul Medical Faculty, Department of Neurosurgery between 1982 and 2012 was undertaken. The records were analyzed for demographic, clinical and radiological findings, surgical interventions (resection, free-hand aspiration and image-guided aspiration), data regarding abscesses (etiological factors, site, size, number, localization and identified microorganism), corticosteroid and antibiotic usage and complications, and the outcomes were reviewed. RESulTS:The male-to-female ratio was 2.2, and the mean age was 26.2±1.25 years. The most common presenting symptom was headache (56.7%), followed by nausea and vomiting (28.5%). Otitis media and mastoiditis were the most common causes of abscess (41.9%), and 44 patients had multiple abscesses. Aerobic gram-positive microorganisms were the most frequently isolated pathogens in culture (51.5%). Primary surgical interventions were as follows: craniotomy and resection (38.8%), free-hand aspiration (49.1%) and image-guided aspiration (12.1%). The aspiration-to-resection ratio was 1.36 (64/47) in the first decade, 2.94 (50/17) in the second decade and 1 (23/23) in the last decade. age, level of consciousness at the time of admission and potent corticosteroid usage were found to be significantly associated with mortality (p=0.001, p≤0.001 and p=0,038, respectively). The total morbidity and mortality ratios were 4.9% and 9.8%, respectively. Seizures were more common in patients of craniotomy group (p=0.023).COnCluSIOn: Treatment of pyogenic brain abscess remains challenging, despite advances in surgical and imaging technology, and craniotomy retains a significant role in surgical treatment.

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Section: Outcomesupporting

confidence: 94%

Section: Surgical Methodsmentioning

confidence: 99%

Section: █ Introductionmentioning

confidence: 99%

Section: █ Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surgery for pyogenic brain abscess over 30 years: evaluation of the roles of aspiration and craniotomy

Aras

Sabancı²,

İzgi³

et al. 2015

Turkish Neurosurgery

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“…11) With surgical excision by craniotomy, the mean mortality in the same period was 12.7%. 11) That review suggests that aspiration may be the first surgical choice in patients with supratentorial parenchymal brain abscesses. However, in our study, mortality was 7% and 6% in the aspiration and excision groups, respectively.…”

Section: Discussionmentioning

confidence: 99%

Aspiration Versus Excision: A Single Center Experience of Forty-Seven Patients With Brain Abscess Over 10 Years

Sarmast

Showkat

Kirmani

et al. 2012

Neurol. Med. Chir.(Tokyo)

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The efficacies of two different surgical approaches, aspiration and excision, were investigated for the management of large solitary encapsulated pyogenic brain abscess located in superficial non-eloquent areas, and the impact on length of hospital stay, duration of postoperative antibiotic use, improvement in neurological status, and morbidity and mortality were compared. This retrospective study at Sher-iKashmir Institute of Medical Sciences included 47 patients with pyogenic brain abscess from a total of 114 patients evaluated in the Department of Neurosurgery over a period of 10 years from October 2001 to October 2011. Comparisons were made between aspiration and excision in terms of duration of antibiotic use, length of hospital stay, and overall treatment cost. Aspiration was performed in 29 patients (61.7%), of whom 7 patients needed second aspiration, and 18 patients underwent excision (38.3%) of the abscess capsule. The mean duration of antibiotic use in the excision group was significantly shorter at 2.7 weeks (standard deviation [SD] ± 1.1) compared to the aspiration group at 3.8 weeks (SD ± 1.3) (p ＝ 0.006). Similarly, mean length of hospital stay was significantly shorter in the excision group at 18.1 days (SD ± 7.7) compared to the aspiration group at 24.9 days (SD ± 6.6) (p ＝ 0.002). In addition, significantly earlier improvement in neurological function (p ＝ 0.025) and significantly lower rate of re-surgery (p ＝ 0.0238) were found in the excision group compared to the aspiration group. Excision is better than aspiration as far as duration of antibiotic use, length of hospital stay, and overall cost of treatment is concerned, with no significant difference in morbidity and mortality.

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Brain and Spinal Infections

Kassim,

Abdulqader,

Abdulsada

et al. 2023

Pediatric Neurosurgery

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A Review of Brain Abscess Surgical Treatment—78 Years: Aspiration versus Excision

Cited by 97 publications

References 11 publications

Surgery for pyogenic brain abscess over 30 years: evaluation of the roles of aspiration and craniotomy

Surgery for pyogenic brain abscess over 30 years: evaluation of the roles of aspiration and craniotomy

Aspiration Versus Excision: A Single Center Experience of Forty-Seven Patients With Brain Abscess Over 10 Years

Brain and Spinal Infections

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