Current Treatment of Brain Abscess in Patients with Congenital Cyanotic Heart Disease

Abstract

Our findings suggest that IVROBA strongly influences poor outcome in patients with cyanotic heart disease. The key to decreasing poor outcomes may be the prevention and management of IVROBA. To reduce operative and anesthetic risk in these patients, abscesses should be managed by less invasive aspiration methods guided by computed tomography. Abscesses larger than 2 cm in diameter, in deep-located or parieto-occipital regions, should be aspirated immediately and repeatedly, mainly using computed tomography-guided methods to decrease intracranial pressure and avoid IVROBA. IVROBA should be aggressively treated by aspiration methods for the abscess coupled with the appropriate intravenous and intrathecal administration of antibiotics while evaluating intracranial pressure pathophysiology.

Efficacy Observation of Continuous Irrigation and Drainage with Double Cavity Catheter in the Treatment of Brain Abscess: 16 Patients Report

“…Marnelak et al proposed to introduce the drainage and antibiotics to the abscess diameter >2.5 cm [10]. Mikihiko et al suggested that the abscess in the diameter of >2 cm, deep abscess or posterior cranial fossa should be repeatedly punctured to reduce the intracranial pressure and prevent cerebral abscess from entering the ventricle [11]. It is difficult to be effective the drainage of the abscess by only puncture and drainage the abscess.…”

Management of brain abscess: an overview

“…12,23,57 Transposition of great vessels, tricuspid atresia, pulmonary stenosis, and double-outlet right ventricle have also been reported as predisposing factors. 12,56,57 Most of these abscesses are supratentorial in location. 23,49,56 Because most of these patients present only with headache, the threshold for performing a CT scan in a patient with cyanotic heart disease should be low.…”

“…These low-perfusion areas commonly occur in the junction of gray and white matter, and they are prone to seeding by microorganisms that may be present in the bloodstream. 28,56 The hematogenous mode of spread accounts for the subcortical location as well as the multiple number of abscesses often encountered in these patients. 7,12,22,57 Streptococcus milleri was the most common organism isolated from the abscess in patients with cyanotic heart disease in one series.…”

“…Craniotomy should be restricted to patients with abscesses resistant to antibiotic therapy. 23,49,56,57 The advent of CT scans and their use in the management of these abscesses has resulted in a fourfold decrease in the mortality rate in patients with brain abscesses secondary to cyanotic heart disease; from 40-60% in the pre-CT era to 1 0%. This could be attributed to early detection, availability of image guidance for aspiration (particularly in small lesions), and better radiological follow-up during the course of the antibiotic therapy.…”

Multiple Cerebellar Abscesses in a 6 Year Old with Uncorrected Congenital Heart Disease: Anaesthetic Challenges

“…Brain abscess is a frequent complication in patients with congenital heart disease [1]. The reported incidence of brain abscess in patients with cyanotic heart disease is 5 -18.7 %with cerebellar abscess comprising 6-35 % of all brain abscesses.…”