Bedside twist drill aspiration of cerebral abscess less than 2.5 cm in size: A case series and discussion
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Published on: July 5, 2011
Tyler Carson1,2, Dan Miulli1,2
1Department of Neurosurgery, Riverside University Health Systems Medical Center, Moreno Valley, California, USA.
Background:
Intracranial abscess remains a potentially deadly condition despite development of newer antibiotics and improved surgical methods. Many studies have evaluated the surgical indications for abscess drainage, and it has been generally accepted that intracranial abscesses greater than 2.5 cm may best be treated with surgical intervention followed by antibiotic therapy. More recently, studies have shown good results with stereotactic aspiration of abscesses to 1 cm in size. Furthermore, a recent case series in 2014 of 103 cases of bedside twist drill aspiration of cerebral abscess >2.5 cm showed a good recovery in 83.4% of cases.
Case Description:
This case series examines the benefits of bedside twist drill aspiration of peripherally located brain abscess less than 2.5 cm in size. In our series, all patients were placed on broad-spectrum antibiotics and had negative blood and cerebrospinal fluid cultures. Our bedside biopsy resulted in de-escalation of antibiotics in 2 of the 3 patients and decreased hospital length of stay.
Conclusion:
In patients with peripherally located brain abscesses less than 2.5 cm in size, bedside twist drill drainage may be a safe and reasonable approach. Positive identification of infective pathogen allows for a decreased hospital length of stay and de-escalation of antibiotics regiment resulting in significant reduction of hospital costs and resources in 2 of the 3 patients treated. This is of benefit to the patient as well as the health system.
Insights
Bedside twist drill aspiration is a safe and effective treatment for smaller brain abscesses (less than 2.5 cm). This procedure can lead to reduced antibiotic use and shorter hospital stays, benefiting both patients and healthcare systems.
Area of Science:
- Neurosurgery
- Infectious Disease
Background:
- Intracranial abscesses are serious infections requiring prompt treatment.
- Traditionally, surgical intervention for abscesses >2.5 cm and stereotactic aspiration for smaller abscesses have been employed.
- Recent studies indicate positive outcomes with bedside aspiration for larger abscesses.
Observation:
- This case series evaluated bedside twist drill aspiration for peripherally located brain abscesses <2.5 cm.
- All patients received broad-spectrum antibiotics with negative blood and cerebrospinal fluid cultures.
- The procedure facilitated antibiotic de-escalation in 2 of 3 patients.
Findings:
- Bedside twist drill drainage is a safe and viable option for brain abscesses <2.5 cm.
- Pathogen identification enabled antibiotic de-escalation.
- Reduced hospital length of stay was observed.
Implications:
- This approach offers a cost-effective and resource-efficient treatment strategy.
- Optimized antibiotic regimens improve patient outcomes and reduce healthcare burdens.
- Bedside aspiration provides a minimally invasive option for managing smaller intracranial abscesses.
