Unusual intracranial suppuration: illustrative cases

Area of Science:

• Neurosurgery
• Infectious Diseases
• Pathology

Background:

• Intracranial suppuration (ICS) encompasses brain abscess, extradural empyema, and subdural empyema, representing rare but serious neurosurgical emergencies.
• Despite advances in antibiotics, neuroimaging, and surgical techniques, sterile ICS remains poorly understood.
• This study details two unique cases of sterile ICS: a sterile subdural empyema and a sterile brain abscess.

Observation:

• Surgical intervention involved craniotomy for pus collection evacuation in both patients.
• Cultures from blood, empyema, and abscess capsule were sterile, indicating an absence of bacterial infection.
• Necrotic brain tissue adjacent to the abscess revealed inflammatory cells, suggesting a non-bacterial inflammatory process.

Findings:

• The presented cases highlight the existence of sterile intracranial suppuration, a condition characterized by pus collections without detectable microbial agents.
• Cultures of bodily fluids and abscess material were negative, ruling out typical bacterial infections.
• Histopathological examination of surrounding brain tissue confirmed inflammation despite sterile cultures.

Implications:

• Sterile ICS represents a distinct clinical entity requiring further investigation to elucidate its underlying etiology.
• The findings underscore the need for enhanced diagnostic approaches and tailored treatment strategies for sterile ICS to improve patient outcomes.
• Additional research is essential to guide the management of this uncommon neurosurgical condition.