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

Abstract

In this study the authors' goal was to present the clinical and imaging results of the combined surgical and medical treatment of intracranial abscesses. 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 approximately 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. 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. Streptococcus and Staphylococcus species were isolated most frequently. No statistically significant difference between causative organisms and clinical outcome was identified (p > 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 < 0.001). A combination of surgical aspiration or removal of all abscesses > 2.5 cm in diameter, a 6-week or longer course of intravenous antibiotics, and weekly neuroimaging should yield cure rates of > 90% in patients with intracranial abscesses.