Navigating the Complexity of Thalamic Abscess: A Systematic Review of Case Studies and Evidence-Based Management

Thalamic abscesses are rare, life-threatening conditions and represent only a few percent of the total cases of brain abscesses. Due to their deep location and critical involvement of sensory and motor pathways, they remain one of the most challenging entities to diagnose and manage. Despite advances in neuro-imaging and neurosurgical techniques, thalamic abscess continues to be a challenge or question in clinical practice regarding optimum treatment modality. Given the nature of the description, a systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Case reports were retrieved after extensive searches in PubMed and Scopus with specified inclusion criteria: isolated thalamic abscesses that needed surgical interventions. The reporting quality was assessed according to CARE (CAse REports) guidelines, while data on clinical presentation and diagnostic approach were extracted. Thirty-three cases with the diagnosis of thalamic abscess were reviewed. The most common presentations included headache, hemiparesis, and altered sensorium. CT and MRI were the common diagnostic tools for these patients; stereotactic aspiration was the most common surgical intervention performed. Streptococcus species were the most common causative organisms. At follow-up, the majority of patients had a good outcome with complete or near-complete recovery. There were rare complications, such as hydrocephalus and recurrence, and mortality was low. Thalamic abscesses are infrequent but have a good prognosis in case of appropriate diagnosis and treatment with stereotactic aspiration and appropriate antibiotic therapy. The present systematic review points out the need for adopting an individual approach to treatment and for further studies that could provide better information on diagnostic and therapeutic strategies regarding this severe disease.