[Pyogenic brain abscesses: experience with 60 consecutive cases]

Brain abscess is a focal suppurative process in the brain parenchyma that still carries high mortality rates. Outcome is closely related with a correct and early management. In order to evaluate this management we have reviewed the brain abscesses treated in our Department during the last 14 years.

The authors present a retrospective series of 60 consecutive patients with pyogenic brain abscess treated between January of 1990 and February of 2004 paying attention to the epidemiology, etiology, clinical data, microbiology, treatment modalities and outcome.

The male to female rate was 5.6 to 1. The average age was 47 years. Hematogenous spread was most frequent, followed by contiguous spread. In 22% of the cases, the origin was unknown. Regarding the causative pathogens, Gram positive cocci are the most frequent (44%), with a 40% incidence of anaerobics. A mixed infection occurred in 39% of the abscesses. Three modalities of treatment were used: non surgical, catheter drainage-aspiration and surgical excision. Outcome was excellent in 52 patients (86.7%) and 4 patients (6.7%) died. Although outcome was similar in both surgical modalities, drainage-aspiration required a second procedure in 20% of the cases while this was necessary in only 10% of the patients with abscess excision. Length of admission was shorter in the drainage-aspiration group than in the excision group (13 and 26 days respectively). Mortality was higher in patients with low level of consciousness and age over 70 years.

The shorter admission time associated with drainage-aspiration of brain abscesses together with its high efficacy and low morbidity suggests that drainage-aspiration should be used as the first mode of treatment.