Brain abscess size and the number of surgical interventions required: a 10-year single-center experience

The authors aimed to determine whether the size of a brain abscess on presentation was related to the number of surgical interventions required to manage it adequately.

Adult and pediatric patients admitted with a brain abscess who underwent surgical intervention between April 2013 and April 2023 at a single neurosurgical unit in the United Kingdom were included. Ordinal logistic regression analysis was conducted to assess whether the size of brain abscess on admission, age, or symptom duration correlated with the number of surgical interventions ultimately required. Furthermore, a Kruskal-Wallis test was conducted to examine the effect of the number of pathogens isolated and the number of predisposing risk factors on the number of surgical interventions required.

Fifty-four patients with a median age of 59 (range 2-85) years were identified; 55% of patients were male. A total of 38 patients underwent 1 procedure, 13 of whom underwent craniotomy and the remainder, burr hole aspiration. Of those who required more than 1 procedure, 10 required 2 aspirations, 3 needed craniotomy following aspiration, 1 patient underwent 3 aspirations, 1 patient needed 2 craniotomies, and another patient required craniotomy followed by 2 aspirations. Abscess size was associated with the number of surgical interventions required (β = 3.056, SE = 1.124, Wald = 7.394; p = 0.007). Other risk factors assessed were not significantly associated with the number of surgical interventions required.

Brain abscess size on presentation is associated with the number of surgical interventions ultimately required for treatment. This observation may serve to counsel patients regarding prognosis and guide management.