Successful treatment of brainstem abscess with stereotactic aspiration

Abstract

BACKGROUND Brainstem abscess is an uncommon condition associated with a high mortality. We report a case of brainstem abscess in a 51-year-old female with a pulmonary arteriovenous fistula that was cured after appropriate antibiotic therapy following stereotactic aspiration. The value of stereotactic aspiration in the management of brainstem abscess is documented with a review of the relevant literature. CASE REPORT A 51-year-old female with a pulmonary arteriovenous fistula suffered fever, diplopia and weakness on the right side. Magnetic resonance (MR) imaging of the brain showed a large cystic mass with ring-like enhancement in the brainstem. A diagnosis of brainstem abscess as a complication of pulmonary arteriovenous fistula was made. MR imaging-guided stereotactic exploration was carried out via the suboccipital transcerebellar approach and the pathogen of the brainstem abscess was identified. The brainstem abscess was cured after treatment employing antibiotics to which the pathogen was sensitive. CONCLUSIONS Stereotactic aspiration is an effective procedure for brainstem abscesses. This procedure is less invasive than open surgery and can be performed even in patients in poor general condition.