Treatment of deep brain abscesses by stereotactic implantation of an intracavitary device for evacuation and local application of antibiotics

Broggi, Giovanni; Franzini, Angelo; Peluchetti, D.; Servello, Domenico

doi:10.1007/bf01418467

Cited by 46 publications

(20 citation statements)

References 14 publications

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“…In addition, intravenous vancomycin at 500 mg every 12 h (dose adjusted for estimated creatinine clearance) was commenced in view of breakthrough abscess formation despite previous broad-spectrum beta-lactam antibiotic use. Empirical local amikacin instillation was used to irrigate the abscess cavity through the abscess drain as described in the literature (1,2). The patient's neurological status improved with no further seizure episodes.…”

Section: / Liter) Liver and Renal Function Test Results Were Unremarmentioning

confidence: 99%

First Report of Brain Abscess Caused by a Satelliting Phenotypic Variant of Helcococcus kunzii

2014

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Helcococcus kunzii was isolated from a brain abscess in a diabetic patient with cholesteatoma and demonstrated satellitism around Staphylococcus aureus in culture. This is the first reported case of severe central nervous system infection due to H. kunzii and the first description of a satelliting phenotypic variant of this organism. CASE REPORTA n 83-year-old man was admitted with a worsening right earache and fever for 10 days. He had a background history of hypertension, diabetes mellitus, and prostate cancer and was on androgen blockade therapy. On admission, he had a temperature of 37.2°C and a fluctuating consciousness level. Otoscopic examination revealed an inflamed outer ear canal. Blood tests showed leukocytosis (13.93 ϫ 10 9 /liter) with neutrophilia (12.19 ϫ 10 9 / liter). Liver and renal function test results were unremarkable. Contrast-enhanced computed tomography scans of the head showed a right-sided cholesteatoma with abscess formation in the mastoid cavity. There was no definite evidence of intracranial extension. Excision of the cholesteatoma and mastoidectomy were performed. Histology showed the presence of keratinized squamous metaplasia consistent with the preoperative diagnosis of cholesteatoma. Cultures of pus swabs obtained from the mastoid abscess were negative for bacterial and fungal growth.In view of the severe clinical infection with systemic upset, the head and neck surgeons in charge started the patient on intravenous ceftriaxone at 2 g every 12 h and intravenous metronidazole at 500 mg every 8 h for broad-spectrum coverage of Gram-negative pathogens, methicillin-sensitive Staphylococcus aureus, and anaerobes. Antipseudomonal coverage was to be added if the patient's condition did not improve. After 2 weeks of intravenous antibiotics, he showed clinical improvement and was switched to oral amoxicillin-clavulanate at 1 g twice daily. However, he developed generalized tonic-clonic convulsions and a high fever 3 weeks after the operation. Reassessment by computed tomography scans of the brain with contrast enhancement showed a right temporal brain abscess (Fig. 1). The abscess was drained surgically. Intravenous ceftriaxone at 2 g every 12 h and intravenous metronidazole at 500 mg every 8 h were restarted. In addition, intravenous vancomycin at 500 mg every 12 h (dose adjusted for estimated creatinine clearance) was commenced in view of breakthrough abscess formation despite previous broad-spectrum beta-lactam antibiotic use. Empirical local amikacin instillation was used to irrigate the abscess cavity through the abscess drain as described in the literature (1, 2). The patient's neurological status improved with no further seizure episodes. In view of the clinical improvement and the results of in vitro antimicrobial susceptibility testing of the bacterial isolate obtained from the brain abscess drainage at the second operation, he was kept on a regimen of ceftriaxone, vancomycin, and metronidazole. Local amikacin instillation through the abscess drain was discontinued. Subsequent c...

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Section: / Liter) Liver and Renal Function Test Results Were Unremarmentioning

confidence: 99%

First Report of Brain Abscess Caused by a Satelliting Phenotypic Variant of Helcococcus kunzii

2014

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“…The introduction of the endoscope advances the goal of minimally invasive techniques in neurosurgery. [7][8][9][10] The benefits of endoscopic or endoscopic-assisted intracranial procedures include shorter convalescence, lower morbidity, and greater patient satisfaction.…”

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confidence: 99%

Endoscopic‐Assisted Intracranial Tumor Removal in Dogs and Cats: Long‐Term Outcome of 39 Cases

Klopp

Rao

2009

Veterinary Internal Medicne

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Background: The benefits of endoscopic assistance to remove intracranial tumors in small animals are not described. Objective: To evaluate the effectiveness of endoscopic-assisted intracranial tumor removal in dogs and cats. Animals: Thirty-three dogs and 6 cats with intracranial tumors. Methods: Retrospective study. CBC, serum chemistry profile, coagulation testing, blood typing, and systemic tumor staging, which included 3-view thoracic radiographs and abdominal ultrasound examination, were performed to detect other significant underlying disease in preparation of the animal for surgery. Magnetic resonance imaging was used in 37/39 cases to image the brain tumor. Surgical approach was dictated by the location of the tumor. Histopathologic examination of the tumor tissue was performed in all cases. Animals were followed throughout their postoperative course for complications and survival times. Statistical analysis (Kaplan-Meier curves) was performed to obtain median survival times in dogs with meningiomas.Results: Use of an endoscope resulted in visualization of residual tumor and potentially more complete removal of the brain tumors. There were no clinically important complications associated with the use of the endoscope. Median survival time was 2,104 days for dogs with forebrain meningiomas surgically removed with endoscopic assistance and 702 days for dogs with caudal brain meningiomas.Conclusions and Clinical Importance: These results demonstrate that the use of an endoscope to assist in brain tumor removal is apparently safe and might result in improved survival times.

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“…In addition to its diagnostic utility, aspiration plays a major role in treatment. Stereotactic aspiration using CT to precisely locate the lesions to be aspirated has been proven to be safe and effective in yielding a diagnosis and improving outcome in both cerebral and brainstem masses [3,[40][41][42][43][44][45]. Among these case series, overall mortality has ranged from 0% to 14% with morbidity rates of 0% to 12%.…”

Section: Surgicalmentioning

confidence: 96%

Brain abscess, subdural empyema, and intracranial epidural abscess

Calfee

Wispelwey

1999

Curr Infect Dis Rep

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Brain abscess, subdural empyema, and intracranial epidural abscess are three of the most commonly encountered focal suppurative processes of the central nervous system. A great deal has been known about the epidemiology and pathogenesis of these entities for quite some time, but until recent years the associated morbidity and mortality remained very high. New imaging techniques have allowed for more rapid detection and more precise localization of these lesions for surgical drainage. Empiric antimicrobial regimens that are effective within the abscess environment and that are directed against the most likely pathogens have also contributed to the improved outcomes seen in the current literature. This article will discuss some of the more recent advances in the diagnosis and treatment of these suppurative lesions within the central nervous system.

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Treatment of deep brain abscesses by stereotactic implantation of an intracavitary device for evacuation and local application of antibiotics

Cited by 46 publications

References 14 publications

First Report of Brain Abscess Caused by a Satelliting Phenotypic Variant of Helcococcus kunzii

First Report of Brain Abscess Caused by a Satelliting Phenotypic Variant of Helcococcus kunzii

Endoscopic‐Assisted Intracranial Tumor Removal in Dogs and Cats: Long‐Term Outcome of 39 Cases

Brain abscess, subdural empyema, and intracranial epidural abscess

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