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Stereotactic Management of Bacterial Brain Abscesses

Published online by Cambridge University Press:  18 September 2015

Sohrab Shahzadi ,
Andres M. Lozano ,
Mark Bernstein ,
Abhijit Guha  and
Ronald R. Tasker
Sohrab Shahzadi
Affiliation:
Division of Neurosurgery, The Toronto Hospital, University of Toronto, Toronto
Andres M. Lozano*
Affiliation:
Division of Neurosurgery, The Toronto Hospital, University of Toronto, Toronto
Mark Bernstein
Affiliation:
Division of Neurosurgery, The Toronto Hospital, University of Toronto, Toronto
Abhijit Guha
Affiliation:
Division of Neurosurgery, The Toronto Hospital, University of Toronto, Toronto
Ronald R. Tasker
Affiliation:
Division of Neurosurgery, The Toronto Hospital, University of Toronto, Toronto
*
Division of Neurosurgery, The Toronto Hospital, University of Toronto. Suite 2–433, 399 Bathurst Street, Toronto, Ontario, Canada M5T2S8
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Abstract:

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Background:

CT and MR guided stereotactic techniques have provided promising results in the management of brain abscesses. We reviewed our results of stereotactic management of brain abscesses in 20 consecutive patients with 28 abscesses from 1986 to 1993.

Methods:

13 abscesses were in the cerebral hemispheres, 12 in the cerebellum, 2 in the pons and 1 in the thalamus. The bacterial organism was isolated in 12 of the 20 cases. All patients, except one who had a tuberculous abscess, were on antibiotics for less than 7 weeks.

Results:

Although there were 3 patients in coma before surgery, the mortality rate was zero and 17 patients had an excellent recovery with 3 patients having a persistent mild neurologic disability. Stereotactic aspiration of the largest lesion in the patients with multiple brain abscesses combined with intravenous antibiotic therapy was sufficient for the resolution of all lesions. Two of our patients treated with antibiotics alone showed abscess progression with neurologic worsening.

Conclusion:

Stereotactic aspiration is safe, accurate, and when combined with the appropriate antibiotics, should be considered the procedure of choice in the management of brain abscesses.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 23 , Issue 1 , February 1996 , pp. 34 - 39
Copyright
Copyright © Canadian Neurological Sciences Federation 1996

References

1.Boom, WH, Tuazon, CU.Successful treatment of multiple brain abscesses with antibiotics alone. Rev Infect Dis 1985; 7: 189–199.CrossRefGoogle ScholarPubMed
2.Stephanov, S, Joubert, MJ.Large brain abscesses treated by aspiration alone. Surg Neurol 1982; 17: 339–340.CrossRefGoogle ScholarPubMed
3.Broggi, G, Franzini, A, Peluchetti, D, Servello, D.Treatment of deep brain abscesses by stereotactic implantation of an intracavitary device for evacuation and local application of antibiotic. Acta Neurochir (Wien) 1985; 76; 94–98.CrossRefGoogle Scholar
4.Choudbury, A, Taylor, JC, Whitaker, R.Primary excision of brain abscess. Br Med J 1977; 2: 1119–1121.CrossRefGoogle Scholar
5.Rosenblum, ML, Hoff, JT, Norman, D, Edwards, MS, Berg, BO.Nonoperative treatment of brain abscesses in selected high-risk patients. J Neurosurg 1980; 52: 217–225.CrossRefGoogle ScholarPubMed
6.Barsoum, AH, Lewis, HC, Cannillo, KL.Nonoperative treatment of multiple brain abscesses. Surg Neurol 1981; 16: 283–287.CrossRefGoogle ScholarPubMed
7.Heineman, HS, Braude, AI, Osterholm, JL.Intracranial suppurative disease: early presumptive diagnosis and successful treatment without surgery. JAMA 1971; 218: 1542–1547.CrossRefGoogle ScholarPubMed
8.Young, RF, Gade, G, Grinnell, V.Surgical treatment for fungal infections in the central nervous system. J Neurosurg 1985; 63: 371–381.CrossRefGoogle ScholarPubMed
9.Bidzinski, J, Koszewski, W.The value of different methods of treatment of brain abscess in the CT era. Acta Neurochir 1990; 105: 117–120.CrossRefGoogle ScholarPubMed
10.Alderson, D, Strong, AJ, Ingham, HR, Selkon, JB.Fifteen-year review of the mortality of brain abscess. Neurosurgery 1981; 8: 1–6.CrossRefGoogle ScholarPubMed
11.Bellar, AJ, Sahar, A, Praiss, I.Brain Abscess. Review of 89 cases over a period of 30 years. J Neurol Neurosurg Psychiatry 1973; 36: 757–768.CrossRefGoogle Scholar
12.Brewer, NS, MacCarty, CS, Wellman, WE.Brain abscess: a review of recent experience. Ann Intern Med 1975; 82: 571–576.CrossRefGoogle ScholarPubMed
13.Garfield, J.Management of supratentorial intracranial abscess: a review of 200 cases. Br Med J 1969; 2: 7–11.CrossRefGoogle Scholar
14.Van Alphen, HAM, Dreissen, JJR.Brain abscess and subdural empyema: factors influencing mortality and results of various surgical techniques. J Neurol Neurosurg Psychiatry 1976; 39: 481–490.CrossRefGoogle ScholarPubMed
15.Rosenblum, ML, Hoff, JT, Norman, D, Weinstein, PR, Pitts, LH.Decreased mortality from brain abscess since advent of computerized tomography. J Neurosurg 1978; 49: 658–668.CrossRefGoogle ScholarPubMed
16.Rajshekhar, V, Chandy, MJ.Successful stereotactic management of a large cardiogenic brain stem abscess. J Neurosurg 1994; 34: 368–371.CrossRefGoogle ScholarPubMed
17.Apuzzo, MLJ.Brain Surgery: Complication, Avoidance and Management. New York: Churchill Livingstone, 1993; 2: 1411–1416.Google Scholar
18.Suwanwela, C, Poshyachinda, V, Poshyachinda, M.Brain scanning in the diagnosis of intracranial abscess. Acta Neurochir 1971; 25: 165–175.CrossRefGoogle ScholarPubMed
19.Stevens, EA, Norman, D, Kramer, RA, Messina, AB, Newton, TH.Computed tomographic brain scanning in intraparenchymal pyogenic abscesses. Am J Neuroradiol 1978; 130: 111–114.Google ScholarPubMed
20.Whelan, MA, Hilal, SK.Computed tomography as a guide in the diagnosis and follow-up of brain abscesses. Radiology 1980; 135: 663–671.CrossRefGoogle ScholarPubMed
21.Berg, B, Franklin, G, Cuneo, R, Boldrey, E, Strimling, B.Nonsurgical cure of brain abscess: early diagnosis and follow up with computerized tomography. Ann Neurol 1978; 3: 474–478.CrossRefGoogle ScholarPubMed
22.Nielsen, H, Gyldensted, C, Harmsen, A.Cerebral abscess: aetiology and pathogenesis, symptoms, diagnosis, and treatment. A review of 200 cases from 1935–1976. Acta Neurol Scand 1982; 65: 609–622.CrossRefGoogle ScholarPubMed
23.Newton, TH, Norman, D, Alvord, EC, Shaw, CM.The CT scan in infectious diseases of the CNS. In: Norman, D, Korobkin, M, Newton, TH, eds. Computed Tomography. San Francisco: University of California Press, 1977; 317–338.Google Scholar
24.de Louvois, J, Gortvai, P, Hurley, R.Bacteriology of abscesses of the central nervous system: a multicentre prospective study. Br Med J 1977; 2: 981–984.CrossRefGoogle ScholarPubMed
25.Patrick, CC, Kaplan, SL.Current concept in the pathogenesis and management of brain abscesses in children. Pediatr Clin N Am 1988; 35: 625–636.CrossRefGoogle ScholarPubMed
26.Everett, ED, Strausbaugh, LJ.Antimicrobial agents and the central nervous system. Neurosurgery 1980; 6: 691–714.CrossRefGoogle ScholarPubMed
27.de Louvois, J.The bacteriology and chemotherapy of brain abscess. J Antimicrob Chemother 1978; 4: 395–413.CrossRefGoogle ScholarPubMed
28.Black, P, Graybill, JR, Charache, P.Penetration of brain abscess by systemically administered antibiotics. J Neurosurg 1973; 38: 705–709.CrossRefGoogle ScholarPubMed
29.Berger, MS.Ultrasound-guided stereotaxtic biopsy using a new apparatus. J Neurosurg 1986; 65: 550–554.CrossRefGoogle Scholar
30.Mundinger, F, Birg, W, Klar, M.Computer-assisted stereotactic brain operations by means including computerized axial tomography. Appl Neurophysiol 1978; 41: 169–182.Google ScholarPubMed
31.Borgstein, RL, Moxon, RA, Hately, W, et al. Preliminary experience with the Berger neurobiopsy device for ultrasound guided aspiration and biopsy of intracranial lesions. Clin Radiol 1991; 44: 98–103.CrossRefGoogle ScholarPubMed
32.Hollander, D, Villemure, JG, Leblanc, R.Thalamic abscess: a stererotactically treatable lesion. J App Neurophysiol 1987; 50: 168–171.Google ScholarPubMed
33.Laborde, G, Klimek, L, Harders, A, Gilsbach, J.Frameless stereotactic drainage of intracranial abscesses. Surg Neurol 1993; 40: 16–21.CrossRefGoogle ScholarPubMed
34.Lunsford, LD, Nelson, PB.Stereotactic aspiration of a brain abscess using the “therapeutic” CT scanner: a case report. Acta Neurochir (Wien) 1982; 62: 25–29.CrossRefGoogle ScholarPubMed
35.Wise, BL, Gleason, CA.CT-directed stereotactic surgery in the management of brain abscess. Ann Neurol 1979; 6: 457.CrossRefGoogle ScholarPubMed
36.Quartey, GRC, Johnston, JA, Rozdilsky, B.Decadron in the treatment of cerebral abscess: an experimental study. J Neurosurg 1976; 45: 301–310.CrossRefGoogle ScholarPubMed
37.Black, KL, Farhat, SM.Cerebral abscess: loss of computed tomographic enhancement with steroids. Case report. Neurosurgery 1984; 14: 215–217.CrossRefGoogle ScholarPubMed
38.Mathisen, GE.Brain Abscess. Conn’s Current Therapy 1995, Edited by Robert, E.Rakel, W. B.Saunders Company, Philadelphia 1995; 788–790.Google Scholar
39.Stapleton, SR, Bell, BA, Uttley, D.Stereotactic aspiration of brain abscesses is the treatment of choice? Acta Neurochiralgica 1993; 121: 15–19.CrossRefGoogle ScholarPubMed
40.Bucci, MN, Carr, WA.Stereotactic neurosurgery in the management of deep lesions in the brain. J S C Med Assoc 1991; 87: 5–7.Google ScholarPubMed
41.Walsh, PR, Larson, SJ, Rytel, MW, Maiman, DJ.Stereotactic aspiration of deep cerebral abscesses after CT-directed labeling. Appl Neurophysiol 1980; 43: 205–209.Google ScholarPubMed
42.Gleason, CA, Wise, BL, Feinstein, B.Stereotactic localization (with computerized tomographic scanning), biopsy, and radio-frequency treatment of deep brain lesions. Neurosurgery 1978; 2: 217–222.CrossRefGoogle Scholar
43.Dandy, WE.Treatment of chronic abscess of the brain by tapping: preliminary note. JAMA 1926; 87: 1477–1478.CrossRefGoogle Scholar
44.Kala, M, Houdek, M.Opening of the ventricular system: a potential preoperative complication of total brain abscess extirpation. Acta Univ Palacki Olomuc Fac Med 1990; 128: 123–126.Google Scholar
45.Dyste, GN, Hitchon, PW, Menezes, AH, Vangilder, JC, Green, GM.Stereotaxic surgery in the treatment of multiple brain abscesses. JNeurosurg 1988; 69: 188–194.Google ScholarPubMed
46.Duma, CM, Kondziolka, D, Lunsford, LD.Image-guided stereotactic management of non-AIDS related cerebral infection. Neurosurg Clin N Am 1992; 3: 291–302.CrossRefGoogle ScholarPubMed
47.Itakura, T, Yokote, H, Ozaki, F, et al. Stereotactic operation for brain abscess. Surg Neurol 1987; 28: 196–200.CrossRefGoogle ScholarPubMed
48.Hall, WA, Martinez, AJ, Dummer, JS, Lunsford, LD.Nocardial brain abscess: diagnostic and therapeutic use of stereotactic aspiration. Surg Neurol 1987; 28: 114–118.CrossRefGoogle ScholarPubMed
49.Goodman, ML, Coffey, RJ.Stereotactic drainage of aspergillus brain abscess with long-term survival: case report and review. Neurosurgery 1989; 24: 96–99.CrossRefGoogle ScholarPubMed
50.Hasdemir, MG, Ebeling, U.CT-guided stereotactic aspiration and treatment of brain abscesses. An experience with 24 cases. Acta Neurochir (Wien) 1993; 125: 58–63.CrossRefGoogle ScholarPubMed