Management of focal intracranial infections: is medical treatment better than surgery?

Risk factors for chronic subdural haematoma formation do not account for the established male bias

“…The significantly younger age for SBDE reflects sinusitis as the principal underlying cause (up to 70%) [23]: however, no sex bias exists for sinusitis (indeed, a female bias may even exist with adult sinusitis [31]). Whilst it is not possible for a single centre to derive sufficient numbers for full SBDE risk factor analysis, a review of cases with requisite information similarly reveals that no risk factor can account for the male bias with SBDE [22][23][24][25][26][27][28][29][30]. A similar male bias between CSDH and SBDE therefore suggests other unknown/unexplored clinical factors common between CSDH and SBDE, or innate anatomical/physiological factors associated with the DBL which are curiously more prevalent in males.…”

“…subdural empyema (SBDE) [22][23][24][25][26][27][28][29][30]. SBDE is not only pathologically dissimilar to CSDH, it is epidemiologically dissimilar (e.g.…”

Brain Abscess

“…An early study of corticosteroid use in a model of S. aureus brain abscess showed that administration of dexaRecent studies suggest that needle aspiration is as effective as abscess excision in the management of most cases of brain methasone interfered with granulation tissue formation as well as bacterial clearance [62]. A later study showed that the use abscess [13,55,61]. In the modern era, most patients can be treated initially with closed-needle aspiration, and surgical of corticosteroids tended to reduce the concentration of certain polar antibiotics (e.g., benzylpenicillin) in infected tissue [63]; excision can be reserved for abscesses that fail to resolve or that are caused by resistant pathogens.…”

“…MRI scanning is essential for the diagnosis of brainstem tients who have undergone open craniotomy with abscess excision (rather than needle aspiration), more recent series have abscess because MRI scanning is the best technique for imaging the brainstem and posterior fossa. Stereotactic needle aspiration demonstrated no clear evidence that either technique of surgical management is more likely to result in long-term seizures of a brainstem abscess, followed by prolonged antimicrobial therapy, appears to be the treatment of choice and has resulted [55,61].…”

Pyogenic brain abscess

“…5,21,65,80 Nowadays, with easy radiological follow-up of the brain abscess and broad-spectrum antibiotics, practitioners tend to choose medical treatment, especially if the pathogen can be diagnosed based on cultures of blood, CSF, or direct aspiration. Leys et al 60 reported on 56 patients who were nonrandomly selected for medical treatment, simple aspiration, or excision of their brain abscess and found no statistically significant difference. In fact, brain abscesses cause too much physiological stress for patients, and surgical stress should not be added if it is not necessary.…”