Stereotactic drainage of brain abscesses

Between 1981 and 1986, 16 patients with brain abscesses underwent computed tomography (CT) guided stereotactic aspiration with (n = 5) or without (n = 11), catheter drainage. Infectious sources were found in 11 patients; 6 patients had concomitant immune suppression. Bacterial or mixed toxoplasmic-fungal or toxoplasmic-viral abscesses were diagnosed in 14 patients. After prolonged antimicrobial treatment, follow-up clinical and radiological evaluations confirmed abscess resolution in 12 patients. The abscess size was smaller in four patients, three of whom died 30-60 days after surgery due to overwhelming systemic opportunistic infections. One patient with a tuberculous brain abscess continued to exhibit gradual abscess regression one year after beginning three-drug antituberculous therapy. No surgical mortality occurred but two patients required evacuation of post-operative intracerebral haematomas that resulted from over-vigorous abscess aspiration. CT stereotactic drainage is a safe and effective technique to diagnose and treat brain abscesses and is mandatory for small or deep-seated lesions. Empirical therapy of suspected brain abscesses is rarely warranted in the era of CT stereotactic surgery.