Clinical features and predictive factors of intraventricular rupture in patients who have bacterial brain abscesses

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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“…6) Surgical treatment can involve either aspiration or excision of the abscess. The choice of procedure has been the subject of much debate.…”

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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“…complication of brain abscesses; factors associated with increased risk of rupture include deep location, location close to a ventricle wall, and the presence of multiple abscesses. 23 …”

Section: Surgical Treatmentmentioning

confidence: 99%

“…30 The most typically isolated microorganisms are Streptococcus and Staphylococcus species. 6,16,19,23,34,40,44 In a review of 130 cases, Tseng and Tseng 40 reported that multiple organisms were identified in 23% of patients. Goodkin et al 12 reported that Ͼ 1 organism was isolated in 39% of 36 positive cultures.…”

Section: Laboratory Studiesmentioning

confidence: 99%

“…29,34,40 Freehand aspiration, stereotactic aspiration, endoscopic aspiration, and craniotomy with excision are the surgical modalities used for treatment of brain abscesses. 14,16,23,25,29,40 The choice of treatment modality depends on the patient's status, the techniques available, and the surgeon's experience; there is no significant difference in outcome between aspiration and excision. 29,39,40,44 Aspiration is the gold standard for treatment of brain abscesses; it is simple and can be easily performed via a bur hole even in critically ill patients at any stage of the abscess.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…The mainstay of treatment for brain abscesses is a combination of antibiotic treatment and surgical intervention; 23 indeed, brain abscess is a surgically treated disease. 33 Surgery not only obtains pus for accurate bacteriological diagnosis but also decreases the number of pathogens and amount of necrotic tissue present and, most importantly, reduces the mass effect and intracranial pressure.…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Management of bacterial brain abscesses

Hakan

2008

FOC

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✓ Brain abscesses are well-known lesions that have been reported from the beginning of the Hippocratic era. They continue, however, to be characterized by problematic and fatal features, even though there have been enormous developments in treatment and diagnostic technologies—especially in the areas of computed tomography (CT), surgery, anesthesia, bacterial isolation techniques, and new antibiotics. The predisposing factors may change according to patient age, geographic location, and socioeconomic conditions of the community, but patients frequently have a contiguous infection such as otitis or mastoiditis. The clinical signs and symptoms of brain abscesses are nonspecific. Patients typically present with signs and symptoms due to mass effects, accompanied by high fever and seizure. The main treatment is surgical, although medical therapy can be used for selected cases. The treatment of choice is aspiration, which may be performed with the aid of an endoscope or free hand, with or without stereotactic or intraoperative ultrasound guidance. Excision is valuable in some cases. The success of the treatment, whether surgical or medical, mostly depends on the success of isolation of the causative organism, which provides essential data for accurate medical treatment. Third-generation cephalosporins and metronidazole are the most commonly used antimicrobial agents in the treatment of brain abscesses. Use of corticosteroids may be acceptable when lesions are accompanied by edema. Prophylactic antiepileptic therapy is strongly recommended. The patient's Glasgow Coma Scale score at presentation is one of the most important factors predicting outcome.

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