Brain abscess: analysis of results in a series of 51 patients with a combined surgical and medical approach during an 11-year period

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>In this study the authors' goal was to present the clinical and imaging results of the combined surgical and medical treatment of intracranial abscesses.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors retrospectively analyzed the data in 51 patients with intracranial abscesses who underwent surgery between January 1997 and November 2007. Patients were treated with aspiration through a single bur hole, total resection with open craniotomy, or image-guided stereotactic aspiration. Computed tomography or magnetic resonance imaging was performed ~ 24 hours after surgery to evaluate the size of the abscess and almost weekly during follow-up until the abscess and/or cerebral edema was reduced. Clinical results were analyzed using modified Rankin Scale (mRS) scores.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>There were 36 male and 15 female patients, and their ages ranged from 14 months to 58 years (mean 29 years). Adjacent localized cranial infection was the most common predisposing factor in 31 patients (61%). Thirty-two patients were treated by repeated aspiration via a single bur hole. <jats:italic>Streptococcus</jats:italic> and <jats:italic>Staphylococcus</jats:italic> species were isolated most frequently. No statistically significiant difference between causative organisms and clinical outcome was identified (p &gt; 0.05). Assessment of overall 1-year clinical outcomes was favorable (mRS Scores 0–2) in 76.5% of patients (39 of 51 patients). The initial neurological condition was strongly correlated with the clinical outcome (p &lt; 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>A combination of surgical aspiration or removal of all abscesses &gt; 2.5 cm in diameter, a 6-week or longer course of intravenous antibiotics, and weekly neuroimaging should yield cure rates of &gt; 90% in patients with intracranial abscesses.</jats:p></jats:sec>

Brain abscess: surgical experiences of 162 cases

“…[31][32][33][34][35][36][37][38] Brain abscesses were singular in 77.7% of the subjects and multiple in 22.3%, a result similar to that reported by Landriel et al [39] The frontal lobe was the most common abscess location in the patients, followed by the temporal and occipital regions. However, in a study carried out by Cavusoglu et al, [40] the temporoparietal region was the most commonly affected location. Abscesses of unknown cause accounted for 54.94% of the subjects, higher than the values reported for other series.…”

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

“…Aspiration was repeated more than once in 30 of 32 (93%) patients who underwent aspiration in a series of 51 patients and only 10 patients underwent complete excision. 3) In another series, 19% of patients treated by aspiration underwent the procedure more than once. 5) A literature review spanning 78 years from 1930 to 2009 concluded that the high mortality from aspiration decreased dramatically after CT became available.…”

“…The anatomical location, number and size of abscesses, stage of abscess formation, and age and neurological status of the patient can influence the strategy for managing brain abscess. 3) Surgical treatment can involve either aspiration or excision of the abscess. The choice of procedure has been the subject of much debate.…”

Surgical Treatment of a Chronic Brain Abscess and Growing Skull Fracture in a Dog

“…Abscesses are treated surgically (by excision or drainage) whenever possible; indications to delay or avoid surgical excision include multiple distantly located abscesses, abscesses in deep or vital brain structures, and concurrent meningitis or ependymitis [16,18,19]. An additional indication to promptly perform surgery in the case reported here was the presence of obstructive hydrocephalus of the right lateral ventricle, as evidenced by severe ventricular dilation with periventricular T2 hyperintensity (consistent with interstitial edema) on the MRI.…”