Twist Drill Aspiration of Pyogenic Brain Abscesses: Our Experience in 103 Cases

Singh, Ishwar; Rohilla, Seema; Kumawat, Manjulata

doi:10.1055/s-0033-1342933

Cited by 4 publications

(4 citation statements)

References 19 publications

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“… 12 13 The treatment of brain abscess is multimodal with parenteral antibiotics for smaller abscess and aspiration or surgical drainage for larger abscesses. 14 For multiloculated abscess cavities that do not respond to antibiotic treatment, surgical excision is advocated. 9 The treatment offered for brain abscess in patients with CCHD seems to be less aggressive with aspiration of the abscess and antibiotics, but recently more patients are being subjected to surgical excision.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Complications and Clinical Outcomes in Patients with Congenital Cyanotic Heart Disease Undergoing Surgery for Brain Abscess

Vimala

Krishnakumar

Goyal

et al. 2020

JNRP

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Background Brain abscess is a rare neurological complication in patients with congenital cyanotic heart disease (CCHD). Perioperative complications are high in patients with CCHD. We evaluated incidence of and risk factors for perioperative complications and their impact on clinical outcomes in patients with CCHD undergoing brain abscess surgery with monitored anesthesia care (MAC) or general anesthesia (GA). Methods In this single-center retrospective cohort study, data were collected from consecutive patients with CCHD who presented with brain abscess and underwent surgery from January 2006 to December 2018. Data regarding demographics, type of CCHD, signs and symptoms of brain abscess and CCHD, type and duration of surgery, details of anesthesia, perioperative complications, and clinical outcomes were collected. Chi-square test was used to analyze nonparametric data and student t-test for parametric data. Results Of the 402 patients with brain abscess, data of 34 patients with CCHD who underwent brain abscess surgery were analyzed. The mean age at presentation of brain abscess was 15.8 ± 10.8 years and duration of symptoms was 17.3 ± 15.5 days. The incidence of perioperative complications was 82.4% (28/34 patients). Seven patients (20.6%) developed perioperative cyanotic spells which led to cardiac arrest in 5 patients (14.7%) and death in 2 patients (5.9%). Patients on cardiac medications and with high heart rate had higher incidence of cyanotic spells and mortality. Technique of anesthesia did not affect cardiac and neurological outcome. Conclusions Perioperative complications are high after brain abscess surgery in patients with CCHD. Perioperative characteristics and outcomes were similar with MAC and GA techniques.

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Section: Discussionmentioning

confidence: 99%

Perioperative Complications and Clinical Outcomes in Patients with Congenital Cyanotic Heart Disease Undergoing Surgery for Brain Abscess

Vimala

Krishnakumar

Goyal

et al. 2020

JNRP

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“…Several studies have explored the feasibility of bedside twist drill aspiration, specifically in peripherally located abscesses sized less than 2.5 cm [35]. A series of 103 patients treated with bedside twist drill aspiration found a mortality rate of 4.8% [36], comparable to the reported mortality rate of typical aspiration.…”

Section: Surgical Managementmentioning

confidence: 94%

Intracranial and Intraventricular Abscess – Neurosurgical Management

Tucci,

McCormack,

Wang

et al. 2023

Abscess - Types, Causes and Treatment

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We will review the most common infections of the ventricular system within the neuroaxis including source, spread and clinical presentation. We will discuss the neurosurgical management of these patients including the indications for surgical management, nonoperative management, when an external ventricular drain is indicated, alternative surgical options and complications. We will review the treatment of the most common infections regarding antibiotic regimens, including when intrathecal therapy is required and how that is administered. Lastly, we will highlight the intracranial abscess, the lethal complication of rupture into the ventricular system, this pathophysiology and management of this devastating disease.

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“…23,24 Advantages and disadvantages of each technique have been reported including the challenges and experiences in developing countries. 25 In the literature, abscess excision has been observed to be associated with decreased recurrence and re-operation rates, decreased duration of antibiotic course, shorter hospital stays, and lower overall cost relative to aspiration. 2,[13][14][15][16]18,23 Excision may be preferred in cases of large, superficial, or multiloculated abscesses, when there is significant mass effect, in trauma-and/or foreign body associated abscesses, and those located in the posterior fossa.…”

Section: Surgical Techniquesmentioning

confidence: 99%

A Canadian National Survey of the Neurosurgical Management of Intracranial Abscesses

Kameda-Smith

Ragulojan

Hart

et al. 2022

Can. J. Neurol. Sci.

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Objective: Intracerebral abscess is a life-threatening condition for which there are no current, widely accepted neurosurgical management guidelines. The purpose of this study was to investigate Canadian practice patterns for the medical and surgical management of primary, recurrent, and multiple intracerebral abscesses. Methods: A self-administered, cross-sectional, electronic survey was distributed to active staff and resident members of the Canadian Neurosurgical Society and Canadian Neurosurgery Research Collaborative. Responses between subgroups were analyzed using the Chi-square test. Results: In total, 101 respondents (57.7%) completed the survey. The majority (60.0%) were staff neurosurgeons working in an academic, adult care setting (80%). We identified a consensus that abscesses >2.5 cm in diameter should be considered for surgical intervention. The majority of respondents were in favor of excising an intracerebral abscess over performing aspiration if located superficially in non-eloquent cortex (60.4%), located in the posterior fossa (65.4%), or causing mass effect leading to herniation (75.3%). The majority of respondents were in favor of reoperation for recurrent abscesses if measuring greater than 2.5 cm, associated with progressive neurological deterioration, the index operation was an aspiration and did not include resection of the abscess capsule, and if the recurrence occurred despite prior surgery combined with maximal antibiotic therapy. There was no consensus on the use of topical intraoperative antibiotics. Conclusion: This survey demonstrated heterogeneity in the medical and surgical management of primary, recurrent, and multiple brain abscesses among Canadian neurosurgery attending staff and residents.1

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Twist Drill Aspiration of Pyogenic Brain Abscesses: Our Experience in 103 Cases

Abstract: Twist drill aspiration is a rapid, safe, and very effective lifesaving procedure in the underdeveloped world where stereotaxy is not readily available.

Cited by 4 publications

References 19 publications

Perioperative Complications and Clinical Outcomes in Patients with Congenital Cyanotic Heart Disease Undergoing Surgery for Brain Abscess

Perioperative Complications and Clinical Outcomes in Patients with Congenital Cyanotic Heart Disease Undergoing Surgery for Brain Abscess

Intracranial and Intraventricular Abscess – Neurosurgical Management

A Canadian National Survey of the Neurosurgical Management of Intracranial Abscesses

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