Brain Abscesses: Clinical Experience and Outcome of 52 Consecutive Cases
M. Radoi, V. Ciubotaru, L. TataranuOriginal article, no. 2, 2013
Background: Brain abscesses are still a very important pathology,
with high mortality and morbidity, even with the advancement
of imaging technologies and antibiotic treatment. In this study,
we analyzed the relationship between clinical, biological and
therapeutic features at admission and clinical outcome in
patients with brain abscesses.
Material and method: This is a retrospective study over 52
consecutive patients with brain abscesses treated in our
Neurosurgical Department during 8 years, between January
2003 and December 2011. Laboratory tests, cerebral CT or MRI
scans, blood and urine cultures were performed. Surgical
treatment consisted of either CT guided stereotactic aspiration
or craniotomy with the resection of the abscess. Materials from
the brain abscess were cultured for aerobic and anaerobic bacteria. Parenteral antibiotic therapy usually lasted between 6
to 8 weeks.
Results: Clinical outcome was assessed at 6 months endpoint
by using Glasgow Outcome Scale (GOS). The most common
cause of brain abscess was hematogenous spread. There were 41
patients with solitary and 11 with multiple brain abscesses.
Regarding microbiological findings, we obtained positive
cultures from brain materials in 41 patients. Stereotactic
aspiration was performed in 33 patients, surgical excision in 15
and medical therapy alone in 4 patients. As clinical outcome,
84.6% patients had a favorable outcome (GOS 5 and 4) and
15.4% had an unfavorable outcome (severe disability – 4 and
death – 4).
Conclusions: Early diagnosis, optimal surgical intervention and
timely use of appropriate antibiotics are essential for a good
outcome. No significant difference in outcome was found
among various surgical treatment modalities. For mortality, initial
Glasgow Coma Score (GCS) < 8, associated predisposing
factors and systemic infections were significant contributing
factors.