Endoscopic ultrasonic aspiration of brain abscess

Intracerebral abscess is a rare, but very serious complication of neonatal sepsis. Aggressive medical and surgical strategy is warranted in patients with large abscesses.

A neonate with bilateral large frontal abscesses, caused by Serratia marcescens, was operated using a neuroendoscope coupled with an ultrasonic aspiration device. To our knowledge, this is the first report of such utilization of this new tool. The left abscess was surgically drained through endoscopic aspiration using ultrasonic aspirator. Clinical condition rapidly improved, and postoperative MRI of the brain revealed an almost complete resolution of the left abscess. A second endoscopic procedure was performed 1 week later, and the right abscess was endoscopically drained with the same technique. The remaining clinical course was uneventful.

Ultrasonic aspiration is effective in obtaining complete removal of the purulent material and of the dense fibrin layer adherent to the capsule. However, further studies are warranted to determine its real effectiveness, compared with the classic technique. In our opinion, it should be considered an option in more difficult cases, such as abscesses caused by aggressive germs in young or immunocompromised patients, or in case of recurrent lesions, in order to avoid craniotomy and open surgery.