Brain-stem abscess successfully treated by microsurgical drainage: a case report

Brain-stem abscess is an uncommon condition associated with high mortality. The best method of treatment is not yet defined. It can be managed by medical treatment alone, stereotactic aspiration of the pus and medical treatment, or surgical excision/drainage of the abscess. We present a case of large brain-stem abscess, treated successfully by surgical drainage after the failure of medical treatment. The patient had a large brain-stem abscess extending from the mid-brain down to the lower pons. She was in a poor neurological condition pre-operatively, and was worsening despite intravenous antibiotics. The abscess was coming close to the surface in the lateral aspect of the mid-brain. The presumed source of infection was multiple dental abscesses. The brain-stem abscess was approached by a subtemporal transzygomatic approach and drained completely after making an incision on the lateral surface of the mid-brain. After the operation, the patient showed steady improvement. At six months after the surgery, the patient was fully conscious, talking fluently, and walking with the help of a walker. Her hemiparesis and co-ordination were improving. Surgical drainage of a brain-stem abscess is indicated when medical therapy fails. Proper anatomical knowledge of the brain-stem and the selection of appropriate surgical approach is important for safe drainage of the abscess.