Clinical Features and Surgical Treatment of Bacterial Brain Abscess

  • Jo, Sung-Dae (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, Eal-Maan (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Lee, Chang-Young (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, In-Soo (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Son, Eun-Ik (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Kim, Dong-Won (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine) ;
  • Yim, Man-Bin (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine)
  • Published : 2007.06.30

Abstract

Objective : This study was performed to review the clinical characteristics and operative results of brain abscess in order to define the therapeutic strategy for this disease. Methods : We reviewed the medical records and radiology images of brain abscess patients treated in our hospital during the last 16 years. A total of 35 cases included 23 males and 12 females, with the mean age of 48 years old. We excluded cases of postoperative, post traumatic, and fungal abscess. All patient underwent at least one surgical treatment such as stereotactic aspiration or craniotomy with excision. Results : Twenty seven [77.1%] patients presented with symptoms of increased intracranial pressure. The frontal lobe was the most common anatomical place, and streptococcal species were the most frequently encountered pathogens. The chronic pulmonary diseases and chronic otitis media are common underlying condition. Eighteen patients underwent stereotactic aspiration and 17 patients had excision of their abscess as an initial treatment. Seven patients had a repeated surgery, 6 of them had been treated with aspiration initially. At discharge, 60.0% patients showed a favorable outcome. Conclusion : The stereotactic drainage would be more suitable for the brain abscess located in deep and eloquent area. A large, solitary, and well-encapsulated lesion of superficial location could be best treated with complete excision, and this procedure was more definite because it is associated with less repeated surgery and showed more favorable outcome compared to aspiration surgery.

Keywords

References

  1. Basit A, Ravi B, Banerji AK : Multiple pyogenic brain abscesses : an analysis of 21 patients. J Neurol Neurosurg Psychiatry 52 : 591-594, 1989 https://doi.org/10.1136/jnnp.52.5.591
  2. Cartes-Zumelzu FW, Stavrou J, Castillo M, Eisenhuber E, Knosp E, Thurnher MM : Diffusion-weighted image in the assesment of brain abscess therapy. AJNR Am J Neuroradiol 25 : 1310-1317, 2004
  3. Ferreira N, Ota GM, Amaral L, Rocha AJ : Imaging aspect of pyogenic infections of the central nerve system. Top Magn Reson Imaging 16 : 145-154, 2005 https://doi.org/10.1097/01.rmr.0000189107.55275.f6
  4. Jeon SR, Kim JH, Ra YS, Roh SW, Kim CJ, Kwon Y : Analysis on surgical outcome of brain abscess. J Korean Neurosurg Soc 28 : 1131-1136 : 1999
  5. Kim DS, Kim YS, Jung KS, Chang JH, Lim CM, Lee JH : Prevalence of chronic obstructive pulmonary disease in Korea : a population-based spirometry survey. Am J Respi Crit Care Med 172 : 842-847, 2005 https://doi.org/10.1164/rccm.200502-259OC
  6. Kim HW, Kim JH, Jung S, Kim SH, Kang SS, Lee JH : Stereotaxy in brain abscess. J Korean Neurosurg Soc 26 : 320-325, 1997
  7. Kutlay M, Colak A, Yildiz S, Demircan N, Akin ON : Sterotaxic aspiration and antibiotic treatment combined with hyperbaric oxygen theraphy in the management of bacterial brain abscesses. Neurosurgery 57 : 1140-1146, 2005 https://doi.org/10.1227/01.NEU.0000186012.95462.E5
  8. Lu CH, Chang WN, Lin YC, Tsai NW, Liliang PC, Su TM : Bacterial brain abscess : microbiological features, epidemiological trends and therapeutic outcomes. QJ Med 95 : 501-509, 2002 https://doi.org/10.1093/qjmed/95.8.501
  9. Mamelak AN, Mampalam TJ, Obana WG, Rosenblum ML : Improved management of multiple brain abscesses : a combined surgical and medical approach. Neurosurgery 36 : 76-86, 1995 https://doi.org/10.1227/00006123-199501000-00010
  10. Mampalam TJ, Rosenblum ML : Trends in the management of bacterial abscesses : a review of 102 cases over 17 years. Neurosurgery 23 : 451-458, 1988 https://doi.org/10.1227/00006123-198810000-00008
  11. Mathisen GE, Johnson JP : Brain abscess. Clin Infect Dis 25 : 763-781, 1997 https://doi.org/10.1086/515541
  12. Ng PY, Sewo WT, Ong PL : Brain abscesses : review of 30 cases treated with surgery. Aust N Z J Surg 65 : 664-666, 1995 https://doi.org/10.1111/j.1445-2197.1995.tb00677.x
  13. Park DH, Lee SH, Lee KS, Chung UW, Park KH, Lee YW : Clinical features and surgical results of brain abscesses. J Korean Neurosurg Soc 37 : 268-271, 2005
  14. Park JH, Yoo DS, Kim DS, Huh PW, Cho KS, Kang JK : Continuos irrigation of brain abscess using a double lumen catheter. J Korean Neurosurg Soc 29 : 1328-1322, 2000
  15. Roche M, Humphreys H, Smyth E, Philips J, Cunney R, McNamar E, et al : A twelve-year review of central nervous system bacterial abscesses; presentation and aetiology. Clin Microbiol Infect 9 : 803-809, 2003 https://doi.org/10.1046/j.1469-0691.2003.00651.x
  16. Shahzadi S, Lozano AM, Bernstein M, Guha A, Taker RR : Stereotaxic management of bacterial abscesses. Can J Neurol Soc 23 : 34-39, 1996 https://doi.org/10.1017/S0317167100039159
  17. Sharma BS, Gupta SK, Khosia VK : Current concepts in the management of pyogenic brain abscess. Neurol India 48 : 105-111, 2000
  18. Sichizya K, Fleggen K, Taylor G, Jonathan P : Brain abscesses-the Groote Schuur experience, 1993-2003. South African J Surg 43 : 79-82, 2005
  19. Stephanov S : Surgical treatment of brain abscess. Neurosurgery 22 : 724-730, 1988 https://doi.org/10.1227/00006123-198804000-00017
  20. Stephanov S, Joubert MJ : Large brain abscesses treated by aspiration alone. Surg Neurol 17 : 338-340, 1992
  21. Strowitzki M, Schwerdtfeger K, Steudel WI : Ultrasound-guided aspiration of brain abscesses through a single burr hole. Minim Invas Neurosurg 44 : 134-140, 2001
  22. Tsai JC, Teng LJ, Hsueh PR : Direct detection of bacterial pathogens in brain abscess by polymerase chain reaction amplification and sequencing of partial 16s ribosomal deoxyribonucleic acid fragments. Neurosurgery 55 : 1154-1162, 2004 https://doi.org/10.1227/01.NEU.0000140842.37422.EE
  23. Xiao F, Tseng MY, Teng LJ, Tseng HM, Tsai JC : Brain abscess : clinical experience and analysis of prognostic factors. Surg Neurol 63 : 442-450, 2005 https://doi.org/10.1016/j.surneu.2004.08.093
  24. Lu CH, Chang WN, Lui CC : Strategies for the management of bacterial brain abscess. J Clin Neurosci 13 : 979-985, 2006 https://doi.org/10.1016/j.jocn.2006.01.048