Analysis of 93 brain abscess cases to review the effect of intervention to determine the feasibility of the management protocol: A tertiary care perspective

Abstract

Context: Brain abscess is a suppurative process within the brain parenchyma, which remains a challenge for clinicians. Surgical excision or aspiration combined with prolonged antibiotics (usually 4–8 weeks) or only conservative management remains the treatment of choice. Aims: The purpose of this study is to analyze the epidemiology of brain abscess and to determine the potential factors leading to better outcomes. Settings and Design: This was a retrospective analysis of 93 patients undergoing various treatment options for brain abscess in a tertiary care center. Materials and Methods: Their preoperative status, etiology, and microbiological and clinical outcomes were analyzed. Statistical Analysis Used: Statistical analysis was done by Chi-square, one-way analysis of variance, and post hoc Newman–Keuls multiple comparison test wherever applicable using SPSS software. Results: Among 93 brain abscess cases, only 21 cases had a diameter <2.5 cm. Among them, conservative treatment was done for 38% of patients (8/21), aspiration for 47.6% (10/21) of patients, and excision for only 3 (14.2%) of cases. About 37.5% (3/8) persons among these conservatively managed patients had recurrence. None of the patients of <2.5 cm abscess having surgical management had recurrence or any new neurological deficits postsurgery during the 6-month follow-up. Conclusions: There was a significantly high recurrence among the nonsurgically treated patients with lesions <2.5 cm and there was no recurrence or neurological deficit after aspiration among these patients. Probably, aspiration has better results among these patients contrary to previous recommendations of antibiotic therapy alone.

Silent Persistent Left Superior Vena Cava Right-to-Left Shunt as a Unique Cause of Recurrent Brain Abscesses

“…Brain abscesses are rare in the adult population, with an estimated incidence of 0.3–0.9 cases per 100 000 inhabitants per year [ 6 ], and even less frequent in the pediatric population [ 7 , 8 ]. Given its rarity in the pediatric population, cardiogenic brain abscess has not been extensively studied [ 9 ].…”

Guided Surgery with Intraoperative Ultrasonography and Endoscopy in Multiple Occipital Brain Abscess

“…(16,17) Other factors that are analyzed when deciding on surgical treatment is the size of the lesion and the proximity to the ventricular system due to the risk of rupture and opening of its purulent content within the ventricular system, it is defined that in abscesses greater than 2, 5 cm surgery is most effectively recommended. (18)…”