Management Of Brain Abscess Research Articles

Management of a large superficial brain abscess with repeated aspirations.

Management of brain abscesses is still an issue of debate. Large superficial abscesses should be totally extirpated through a craniotomy. We present a case of a 66-year old man with a brain pyogenic abscess, without neurological symptoms and signs, without positive cultures, larger than 4cm in size, located superficially who was treated successfully by two repeated aspirations without intracavitary application of antibiotics. We conclude that it is effective to treat a large superficial in capsular stage brain abscess with repeated elective aspirations, since the clinical picture of the patient is mild.

Brain abscesses in Malawian children: value of CT scan

The clinical presentation and management of brain abscess in three HIV-uninfected Malawian children are reported. One case was associated with staphylococcal empyema and severe malarial anaemia and another case with chronic suppurative otitis media and mastoiditis. The third case had no identified extracranial focus of infection. These cases illustrate the difficulties of diagnosis and management of brain abscesses in the resource-poor setting where other causes of encephalopathy caused by infection are common, and highlight the value of neuroradiological imaging.

Stereotactic Aspiration and Antibiotic Treatment Combined with Hyperbaric Oxygen Therapy in the Management of Bacterial Brain Abscesses

AbstractOBJECTIVE:Despite advances in surgical techniques in the management of the brain abscess, long-term antibiotics are as crucial to cure as the initial surgical procedure itself. This study was designed to evaluate the effect of adjuvant hyperbaric oxygen (HBO) therapy on the duration of antibiotic treatment.METHODS:Between 1999 and 2004, 13 patients with bacterial brain abscesses treated with stereotactic aspiration combined with HBO and systemic antibiotic therapy. Patients younger than 18 years of age were excluded from this study. Postoperatively, all patients were given a 4-week course of intravenous antibiotics. Additionally, patients received hyperbaric oxygen (HBO, 100% O2 at 2.5 ATA for 60 min) twice daily for five consecutive days, and an additional treatment (100% O2 at 2.5 ATA for 60 min daily) was given for 25 days.RESULTS:There were eight male and five female patients. Their ages ranged between 18 and 71 years, with a mean of 43.9 years. The average duration of follow-up was 9.5 months (range, 8–13 mo). This treatment modality allowed infection control and healing for all 13 patients with 0% recurrence rate. HBO treatment was tolerated well, and there were no adverse effects of pressurization. At the end of the follow-up period, 12 patients had a good outcome: nine are without sequelae, and three have a mild hemiparesis but are capable of self-care. One patient has a moderate hemiparesis.CONCLUSION:Although the number of patients is small, this series represents the largest reported group of brain abscess patients treated with stereotactic aspiration combined with antibiotic and HBO therapy. Our preliminary results indicate that the length of time on antibiotics can be shortened with the use of HBO as an adjunctive treatment.

Diagnosis and management of brain abscess and subdural empyema

Advances in the diagnosis and treatment of brain abscess and subdural empyema with neuroimaging techniques such as computerized tomography, magnetic resonance imaging, magnetic resonance spectroscopy, the availability of new antimicrobials, and the development of novel surgical techniques have significantly contributed to the decreased morbidity and mortality associated these infections. Determination of point of entry and source of infection is paramount to adequate treatment. A high index of suspicion along with typical clinical presentation of headache, seizures, or focal neurologic signs can lead to early diagnosis so that effective therapy can be instituted as soon as possible. This review discusses etiology and pathology of brain abscess and subdural empyema, neuroimaging techniques useful in the diagnosis, and optimal treatment, including use of antimicrobials and surgical procedures.

Causes and Management of Brain Abscess

The microbiology and recent developments in the diagnosis and management of brain abscess in children are reviewed from Georgetown University School of Medicine, Washington, DC.

Management of Brain Abscess and Lateral Sinus Thrombosis of Otogenic Origin: A Multidisciplinary Team Approach and Review of Literature

In this era of antibiotics the incidence of brain abscess and lateral sinus thrombosis (LST) secondary to chronic suppurative otitis media (CSOM) should not be underestimated and the management still remains a clinical challenge. We review the clinical records of patients who presented with temporal lobe abscess (Case 1), cerebellar and extradural abscess (Case 2) and LST (Case 3) of otogenic origin and discuss the importance of multidisciplinary team approach in the management of these high-risk cases. We review the literature in detail and discuss the epidemiology, clinical presentation, diagnostic modalities, treatment options and controversies in the management of brain abscess and LST.

The management of brain abscesses.

Objectives. To review the current trends in the management of brain abscesses.KeywordsBrain AbscessHereditary Hemorrhagic TelangiectasiaCerebral AbscessIntracranial AbscessIntracranial Mass LesionThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Advances and Technical Standards in Neurosurgery

Journal of Molecular Neuroscience 49 Volume 21, 2003 Pickard, J. D., Dolenc, V. V., Lobo Antunes, J., Reulen, H.-J., Sindou, M., Strong, A. J., de Tribolet, N., Tulleken, C. A. F., and Vapalahti, M., eds. (2003) Advances and Technical Standards in Neurosurgery, Vol. 28, Springer Wien, New York. This up-to-date book features recent advances in stem cell neurobiology (T. Ostenfeld, C. N. Svendsen), mapping of the neuronal networks of human cortical brain functions (S. Momjian, M. Seghier, M. Seeck, C. M. Michel), and technical standards, including the management of brain abscesses (S. Livraghi, J. P. Melancia, J. Lobo Antunes), respective indications for radiosurgery in neuro-otology surgery for acoustic schwannoma (W. Pellet, J. Regis, P.-H. Roche, C. Delsanti) with commentary (R. Macfarlane, D. Moffet), cerebral revascularization (H. J. N. Streefkerk, A. Van der Zwan, R. M. Verdaasdonk, H. J. Mansveld Beck, C. A. F. Tulleken), and surgical anatomy of the temporal lobe for epilepsy surgery (M. Sindou, M. Guenot). The review provided below cites, to a great extent (and, on occasion, using the same words), the excellent abstracts written for each chapter. A personal viewpoint is added with references below, especially pertaining to stem cell technology.

Stereotactic surgery in the management of brain abscess

BACKGROUNDBacterial brain abscesses can be diagnosed and treated with stereotactic aspiration.METHODSFrom 1991 to 1997 we have used computed tomography-guided stereotactic aspiration to diagnose and treat 21 patients with a total of 58 bacterial brain abscesses. The ages of the patients ranged from 4 to 72 years (median 25 years); 11 of these 21 patients had multiple abscesses. The number of abscesses per patient with multiple abscesses ranged from 2 to 9, all located deep in subcortical white matter.RESULTSAll patients underwent stereotactic surgical drainage and an 8-week intravenous antibiotic medical treatment. Of the 58 abscesses, 23 were aspirated. Of these 23 abscesses, 19 were radiologically stage III or IV and four were stage I or II. Pathological examination confirmed radiological staging in 19 patients (83%). Except for the three patients who have mild residual hemiparesis and one patient recovering from ataxia, all patients had complete neurological recovery.CONCLUSIONSComputed tomography-guided stereotaxy achieved all the objectives of management; namely, ascertaining the diagnosis, draining the content of the mass, and obtaining pus for accurate bacteriological diagnosis without morbidity. Stereotactic aspiration combined with an 8-week intravenous antibiotic regimen has yielded an effective therapeutic result in all of our abscesses, small or large, solitary or multiple, superficial or deep-seated. A high radiological-pathological correlation was also deduced from this study.

The management of brain abscess in a developing country: are the results any different?

A retrospective study of 57 surgically-managed brain abscesses at the Neurosurgical Unit, Bir Hospital during a 6-year period from October 1990 is presented. Detailed hospital case notes could be traced in only 37 cases, consisting of 25 males and 12 females with age range from 5 months to 60 years. Cryptogenic abscess was the commonest category followed by abscess caused by chronic ear infection. The diagnosis was made with enhanced computed tomography (CT) in all the cases. Positive bacteriology was found in only nine cases. The treatment consisted of 6 weeks of intensive intravenous antibiotics and emergency surgical drainage of the abscess. Five out of the total cases died (13.5%). These patients were all in an extremely poor condition at the time of presentation. All the survivors made a good recovery. With timely CT diagnosis, surgical drainage and antibiotics, good results can be achieved even in a developing country.

O-8-108 - Management of brain abscesses: Experience with repeated aspiration and drainage through flexible tube

O-8-108 - Management of brain abscesses: Experience with repeated aspiration and drainage through flexible tube

O-8-110 - Management of brain abscess in patients with congenital cyanotic heart disease

O-8-110 - Management of brain abscess in patients with congenital cyanotic heart disease

Stereotactic Management of Bacterial Brain Abscesses

CT and MR guided stereotactic techniques have provided promising results in the management of brain abscesses. We reviewed our results of stereotactic management of brain abscesses in 20 consecutive patients with 28 abscesses from 1986 to 1993. 13 abscesses were in the cerebral hemispheres, 12 in the cerebellum, 2 in the pons and 1 in the thalamus. The bacterial organism was isolated in 12 of the 20 cases. All patients, except one who had a tuberculous abscess, were on antibiotics for less than 7 weeks. Although there were 3 patients in coma before surgery, the mortality rate was zero and 17 patients had an excellent recovery with 3 patients having a persistent mild neurologic disability. Stereotactic aspiration of the largest lesion in the patients with multiple brain abscesses combined with intravenous antibiotic therapy was sufficient for the resolution of all lesions. Two of our patients treated with antibiotics alone showed abscess progression with neurologic worsening. Stereotactic aspiration is safe, accurate, and when combined with the appropriate antibiotics, should be considered the procedure of choice in the management of brain abscesses.

Brain abscess and subdural empyema

Notable contributions have been made recently in the diagnosis and management of brain abscesses and subdural empyema. Several articles present an international perspective, echoing much of the Western literature, including a profound decrease in mortality with the availability of computed tomography and early recognition and treatment. Diagnostic studies have highlighted the superiority of magnetic resonance imaging to computed tomography in the detection of subdural empyema and the potential value of positron emission tomography. Novel diagnostic tools, including 99mTc-hexamethylpropyleneamine oxime leukocyte scintigraphy and C-reactive protein levels, have been evaluated and show great promise. Surgical studies comparing stereotactic drainage with craniotomy for brain abscesses and burr hole versus craniotomy drainage of subdural empyema suggest the efficacy of these more limited procedures. Local instillation of antibiotics is a potentially effective adjunct for refractory brain abscesses. Recent studies suggest that the most significant predictors of poor outcome are the patient's level of consciousness and the rapidity of disease progression prior to the initiation of treatment.

Factors that enhance the likelihood of successful stereotactic treatment of brain abscesses.

Successful clinical outcomes are not achieved in all patients who undergo image-guided stereotactic surgery as the initial procedure in the management of brain abscess. We sought to define those factors related to management failure, so that the initial surgical approach could be selected using preoperative clinical or imaging criteria. We reviewed our twelve-year experience in 29 consecutive patients. Twenty-two (76%) patients had drainage of abscesses with purulent centers. Seven (24%) underwent lesion biopsy for diagnosis. Twelve patients (with abscesses > 3 cm in average diameter) underwent stereotactic insertion of drainage catheters. Ten patients (34%) had adverse risk factors including immunologic suppression after prior organ transplantation, chronic steroid therapy, prior antineoplastic chemotherapy, or retained foreign body. Microbiological identification of the causative organism was obtained in 22 patients; 6 patients had positive Gram stains without growth in culture (bacteriological diagnosis = 97%). Long-term clinical evaluation (up to 8.5 years, median 3 years) confirmed disease resolution after initial single-procedure stereotactic management in 21 patients (72%). Eventual abscess resolution occurred in an additional 6 patients (21%), all of whom required multiple procedures. Five patients died of complications of their systemic disease during the follow-up period. Fifteen of the 18 (83%) surviving patients who had no associated risk factors returned to their premorbid functional capacity. Factors associated with initial treatment failure included inadequate aspiration, lack of catheter drainage of larger abscesses, chronic immunosuppression, and insufficient antibiotic therapy.

Management of brain abscess in children: review of 130 cases over a period of 21 years.

The data on 130 children with brain abscesses treated over 21 years (1970-1990) were analyzed retrospectively. The whole group included four infants. Chronic ear infection and cyanotic congenital heart disease were the most common predisposing factors. In infants, meningitis and/or ventriculitis were dominant in the etiopathogenesis. Cases were evaluated according to the treatment received and also according to time periods. More than half of the patients (n = 74) in this series were treated by primary or secondary excision. Computed tomography (CT) facilitated the diagnosis and helped the planning of treatment. Aspiration gained increasing credit after the advent of CT. Microorganisms could be identified in 54% of the cultured specimens. Staphylococci, streptococci and Proteus were the dominating microorganisms. Penicillin and chloramphenicol have long been the mainstay of antimicrobial therapy but have recently been replaced by third-generation cephalosporins and sulbactam-ampicillin combinations. Overall mortality was 15.5% but showed a decline from 30% in the pre-CT era to 6% in the last 5 years and to zero in the last three. Neither the location nor associated heart disease contributed to the mortality, but mortality among infants was as high as 50%.

Diagnosis and Management of Brain Abscess

Over the past 20 years, the diagnosis and management of brain abscess has been facilitated by a number of technologic advances that have resulted in a significant reduction in mortality. Despite these advances in technology, however, brain abscess remains a serious disease. In this article the nature, pathogenesis, and diagnosis of brain abscesses are discussed. Issues regarding surgical versus nonsurgical management, optimal surgical therapy, choice and duration of antibiotics, and the use of corticosteroids are examined in terms of their impact on mortality and long-term neurologic sequelae.

Clinical analysis and results of operative treatment of 41 brain abscesses

In this study, 41 cases of cerebral abscess operated on in our clinics between 1977 and 1986 were investigated retrospectively. The surgical strategy and the factors affecting the mortality rate were discussed. It was confirmed that the most important factor affecting the mortality rate was the consciousness level of patients in the preoperative period. The importance of computed tomography (CT) for early diagnosis and management of brain abscess is stressed.

Current Concepts in the Pathogenesis and Management of Brain Abscesses in Children

Brain abscesses represent the most frequent intracranial suppurative process occurring in children. Improved bacteriologic techniques for isolating anaerobic microorganisms have shown that anaerobes play a major role in brain abscesses in conjunction with aerobic organisms such as alpha-streptococci. Computerized tomography has improved the diagnosis of brain abscesses and has changed the management in certain circumstances. Although surgical drainage still remains the definitive treatment modality, conservative medical management with serial CT scans has been successful. Still, the mortality and morbidity of brain abscesses remain substantial.

CT‐directed stereotactic surgery in the management of brain abscess

CT‐directed stereotactic surgery in the management of brain abscess