Advantages of Stereotactic Aspiration on Surgical Management of Pyrogenic Brain Abscesses

Abstract

Objective: To evaluate the effectiveness of computed tomography (CT)-guided stereotactic aspiration of brain abscesses. Patients and Methods: Patients (9 male, 4 female; age range, 12-75 years; mean, 43 years) with an imaging-confirmed brain abscess underwent Brown-Roberts-Wells stereotactic aspiration craniotomy/craniectomy of the abscess under local or general anesthesia. Postoperatively, all patients underwent CT and received antibiotic therapy for 6-8 weeks. Antibiotics were selected on the basis of culture and sensitivity results whenever possible. Results: Bacterial cultures or Gram stains revealed Streptococcus viridans in 5, unidentified gram-positive bacilli in 2, and gram-positive cocci in 1. Underlying disease was noted in 8 patients: Two had chronic otitis media, 2 had systemic lupus erythematosus, and 1 each had diabetes mellitus with liver cirrhosis, nasopharyngeal carcinoma, pulmonary tuberculosis, and basal skull fracture. Eight patients underwent 1 aspiration procedure, and 3 patients underwent 2. After aspiration and appropriate antibiotic treatment, 9 patients had good outcomes, 1 had the same neurologic deficit as before, and 1 died from severe brain swelling and sepsis. The 2 patients undergoing craniotomy recovered. Conclusions: CT-guided stereotactic aspiration of a brain abscess is minimally invasive and allows confirmation of the culture-based diagnosis, enabling physicians to choose the proper antibiotic therapy. This procedure is particularly advantageous in managing deep-seated abscesses, multiple abscesses, or those in the eloquent brain. Aspiration of infected pus also reduces the intracranial volume. Craniotomy with removal of abscess should probably be reserved for severe brain swelling that compromises brainstem function. Further study is needed.