Endoscopic Stereotactic Treatment of Brain Abscesses

Hellwig, Dieter; Bauer, B. L.; Dauch, W. A.

doi:10.1007/978-3-7091-6908-7_18

Cited by 25 publications

(18 citation statements)

References 21 publications

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“…This technique allows the neurosurgeon to inspect and directly view the aspiration of the purulent collection, unlike stereotactic aspiration in which there is a lack of direct visual control. 33,41,50,60 In addition, multiloculated abscesses could possibly be treated with the endoscopic technique. Recently, Longatti et al 60 reported that neuroendoscopic drainage of 4 brain abscesses did not differ significantly from cases performed with stereotactic aspiration in terms of the number of postoperative CT scans, length of hospital stay, and duration of antibiotic therapy.…”

Section: Surgical Managementmentioning

confidence: 99%

Management of brain abscesses in children

Frazier¹,

Ahn²,

Jallo³

2008

FOC

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✓ Brain abscesses occur infrequently but continue to be problematic for the pediatric neurosurgical community. The incidence of brain abscesses in children has not changed much, although individual reports may show an increase or decrease in the number of reported cases depending on the patient population studied. An increase could be attributed to earlier detection due to advancements in imaging modalities and/or to an increase in the number of children with immunodeficient states caused by AIDS, chemotherapy for malignant lesions, and immunosuppressive therapy for organ transplantation. A decrease in the incidence of brain abscesses could be attributed to practices such as antibiotic treatment for otitis media, sinusitis, and/or prophylactic antimicrobial treatment for congenital heart disease in children. The morbidity and mortality rates associated with brain abscesses have not changed dramatically in the antibiotic and imaging era, and their preferred management can vary among healthcare providers. These lesions have been successfully treated by neurosurgeons. The causes of brain abscesses are highly variable in children, which is also the case in adults, but the predisposing factors in the pediatric population differ in prevalence. Cyanotic congenital heart disease, hematogenous dissemination, contiguous infection, and penetrating traumatic injuries are the most common causes of brain abscesses in children. In this review, the authors discuss the causes and medical and surgical management of brain abscesses in children.

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Section: Surgical Managementmentioning

confidence: 99%

Management of brain abscesses in children

Frazier¹,

Ahn²,

Jallo³

2008

FOC

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“…They aspirated the pus and washed the cavity with antibiotics. Both Hellwig et al 42 and Kamikawa and colleagues 48 reported their experiences with a flexible scope (freehand or stereotactically guided), whereas Fritsch and Manwaring 30 opted for a rigid one in a pediatric series. Longatti et al reported the usefulness of flexible endoscopes in certain crucial surgical actions, such as aspirating and inspecting the abscess in all spatial directions or coping with a firm and elastic membrane that requires scissors or other instruments for its perforation.…”

Section: Surgical Managementmentioning

confidence: 99%

“…Longatti et al reported the usefulness of flexible endoscopes in certain crucial surgical actions, such as aspirating and inspecting the abscess in all spatial directions or coping with a firm and elastic membrane that requires scissors or other instruments for its perforation. 42,61 Hellwig et al maintained that drainage catheters need not be inserted inside the abscess after endoscopy (to be used for antibiotic infusion and further aspiration during the following days), whereas Fritsch and Manwaring reported placing catheters in all cases. Longatti et al avoided drain insertion in 1 patient only, and no second operation was needed because no residual abscesses with a space-occupying effect occurred; conversely, Hellwig et al performed subsequent operations in 4 of their patients.…”

Section: Surgical Managementmentioning

confidence: 99%

Pyogenic brain abscess

Erdoğan

Cansever²

2008

FOC

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✓ Brain abscesses have been one of the most challenging lesions, both for surgeons and internists. From the beginning of the computed tomography (CT) era, the diagnosis and treatment of these entities have become easier and less invasive. The outcomes have become better with the improvement of diagnostic techniques, neurosurgery, and broad-spectrum antibiotics. Atypical bacterial abscesses are more often due to chemotherapy usage in oncology, long life expectancy in patients with human immunodeficiency virus (HIV) infection, and immunosuppression in conjunction with organ transplantation. Surgical treatment options showed no significant difference with respect to mortality levels, but lower morbidity rates were achieved with stereotactically guided aspiration. Decompression with stereotactically guided aspiration, antibiotic therapy based on results of pus culture, and repeated aspirations if indicated from results of periodic CT follow-up scans seem to be the most appropriate treatment modality for brain abscesses. Immunosuppression and comorbidities, initial neurological status, and intraventricular rupture were significant factors influencing the outcomes of patients. The pitfalls and evolution in the diagnosis and treatment of brain abscesses are discussed in this study.

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“…In addition to its diagnostic utility, aspiration plays a major role in treatment. Stereotactic aspiration using CT to precisely locate the lesions to be aspirated has been proven to be safe and effective in yielding a diagnosis and improving outcome in both cerebral and brainstem masses [3,[40][41][42][43][44][45]. Among these case series, overall mortality has ranged from 0% to 14% with morbidity rates of 0% to 12%.…”

Section: Surgicalmentioning

confidence: 96%

Brain abscess, subdural empyema, and intracranial epidural abscess

Calfee

Wispelwey

1999

Curr Infect Dis Rep

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Brain abscess, subdural empyema, and intracranial epidural abscess are three of the most commonly encountered focal suppurative processes of the central nervous system. A great deal has been known about the epidemiology and pathogenesis of these entities for quite some time, but until recent years the associated morbidity and mortality remained very high. New imaging techniques have allowed for more rapid detection and more precise localization of these lesions for surgical drainage. Empiric antimicrobial regimens that are effective within the abscess environment and that are directed against the most likely pathogens have also contributed to the improved outcomes seen in the current literature. This article will discuss some of the more recent advances in the diagnosis and treatment of these suppurative lesions within the central nervous system.

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Endoscopic Stereotactic Treatment of Brain Abscesses

Cited by 25 publications

References 21 publications

Management of brain abscesses in children

Management of brain abscesses in children

Pyogenic brain abscess

Brain abscess, subdural empyema, and intracranial epidural abscess

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