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Stereotaxic surgery in the treatment of multiple brain abscesses
G N Dyste1, P W Hitchon, A H Menezes
1Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City.
Abstract:
Controversy exists regarding the optimal treatment for patients with multiple brain abscesses. These lesions are often small and located deep in the brain and close to vital structures, making surgery difficult. With this in mind the authors review their experience in treating multiple abscesses using computerized tomography (CT)-guided stereotaxic aspiration. From 1983 to 1985, 15 patients were treated for multiple brain abscesses, of whom eight underwent stereotaxic aspiration. There were a total of 28 abscesses in these eight patients: 11 abscesses were aspirated and two excised using CT-guided techniques. Most were cortical in location, although there were 12 in the deep white matter, one in the thalamus, and two in the caudate nucleus. All patients received a total of 6 weeks of antibiotic therapy. Follow-up CT showed resolution of the abscesses in all patients. Currently, four are neurologically normal, one has a mild hemiparesis, one has a well-controlled seizure disorder, and one requires supportive care. A single death occurred 5 weeks postoperatively of unrelated causes. Location, size, and age of an abscess all have bearing upon the response to management and outcome of the patient. Stereotaxic surgery is a procedure with minimal morbidity and mortality. Stereotaxic aspiration should be considered in patients with small, multiple, or deep-seated abscesses, in those who are poor operative candidates, and in those who have failed prior therapy.
Insights
Computerized tomography (CT)-guided stereotactic aspiration effectively treats multiple brain abscesses, including deep-seated ones. This minimally invasive approach offers good outcomes for patients unsuitable for traditional surgery.
Area of Science:
- Neurosurgery
- Radiology
- Infectious Diseases
Background:
- Optimal treatment for multiple brain abscesses remains debated.
- Lesions are often small, deep, and near critical brain structures, complicating surgical access.
Purpose of the Study:
- To review the authors' experience with computerized tomography (CT)-guided stereotactic aspiration for multiple brain abscesses.
- To evaluate the efficacy and safety of this minimally invasive technique.
Main Methods:
- Retrospective review of 15 patients with multiple brain abscesses treated between 1983 and 1985.
- Eight patients underwent CT-guided stereotactic aspiration or excision of 28 abscesses.
- All patients received 6 weeks of antibiotic therapy.
Main Results:
- Follow-up CT scans demonstrated complete resolution of abscesses in all treated patients.
- Neurological outcomes included four patients neurologically normal, one with hemiparesis, one with seizures, and one requiring supportive care.
- A single unrelated death occurred 5 weeks postoperatively, indicating low procedure-related mortality.
Conclusions:
- CT-guided stereotactic aspiration is a safe and effective treatment for multiple, small, or deep-seated brain abscesses.
- The procedure is particularly beneficial for patients with poor surgical candidacy or those who failed prior treatments.
- Abscess characteristics like location, size, and age influence patient outcomes.