Ultrasound-Guided Aspiration of Brain Abscesses Through a Single Burr Hole

Abstract

Surgical aspiration and/or drainage of brain abscesses is considered to be the first-line treatment for abscesses larger than 25 mm. This is ususally performed with the aid of CT-guided stereotaxy. A method of ultrasound guidance is presented that allows a single burr hole approach with real-time imaging of the whole procedure. A bayonet-like shaped ultrasound probe with tip dimension of 8 x 8 mm only (EUP-NS 32, Hitachi/Ecoscan) with frequencies of 3.5 and 5 MHz is used. After placement of a burr hole the target is identified by transdural insonation, a guideline is adjusted and a mounted puncture-adapter guides the cannula towards the lesion under real-time imaging control. Up to now 12 abscesses in 10 patients were treated. Visualization was always excellent. A second aspiration had to be performed twice. One abscess did not contain enough pus to be cured by aspiration and was removed by open surgery, another could not be tapped by the blunt cannula and was aspirated under stereotactic control using a sharp trocar. Outcome was excellent in 6 patients and fair in 2 patients but this was due to the pre-existing disease. Two patients admitted in deep coma died despite an emergency operation. The presented method has proven to be a very powerful guiding tool in the surgical treatment of brain abscesses through a single burr hole approach.

First-line Stereotactic Treatment of Thalamic Abscesses: Report of Three Cases and Review of the Literature

“…In addition, the use of DWI requires the presence of a neuroradiologist, and unfortunately not all hospitals are equipped with such a team, leading to a search for other methods of diff erential diagnosis. Recently, stereotactic abscess aspiration has become the treatment of choice particularly in deep-seated abscesses, as this technique permits microbiological diagnosis and drainage of the abscess fl uid with reduced mortality and morbidity [2,3,11,15,22,35] . Many authors report the use of neuronavigation instead of stereotactic frame-based procedures for the drainage of brain abscess, and similar results were obtained with these two techniques [2,6,20,26] .…”

Otogenic Intracranial Abscesses: A Case Series

“…This technique has been used as first-line treatment for abscesses larger than 25 mm [18]. The main drawback of this technique is that aspiration of the abscess usually needs to be repeated as total removal of pus is rarely possible in a single procedure [14].…”

Otogenic brain abscess: management by otologist

“…2 Strowitzki et al recommended ultrasound-guided aspiration of brain abscess through a single burr hole as first-line treatment for abscesses larger than 25 mm. 3 Based on CT staging, Srinivasan et al treated 37 cases of encapsulated brain abscess with repeated elective aspiration through a burr hole and intracavity application of antibiotics on alternate days, until two consecutive negative aspirations were obtained; the mortality rate was 2.7 per cent and the morbidity rate 8.3 per cent. 8 Brydon and Hardwidge concluded that burr hole aspiration with regular CT was a satisfactory method of treatment for cerebellar abscess.…”