Mapping the healing brain: Longitudinal MRI volumetrics and outcomes across surgical techniques for primary brain...

Primary intracerebral abscesses are rare but life-threatening infections requiring prompt surgical and antibiotic treatment. Comparative outcome data on neurosurgical techniques and radiological evolution remain limited.

Do clinical outcomes and MRI-based volumetric changes differ between stereotactic aspiration, craniotomy, and burr-hole trepanation in adults and children with primary intracerebral abscesses?

We retrospectively reviewed surgically treated patients between 2014 and 2024 at the LMU University Hospital in Munich. Abscess and perilesional edema volumes were quantified on serial MRI at clinically defined follow-up intervals. Clinical outcomes were assessed using standardized neurological and functional scales, and recurrence was further evaluated. Adult and pediatric subgroups were analyzed separately.

Sixty patients underwent stereotactic aspiration (53.3 %), craniotomy (36.7 %), or burr-hole trepanation (10.0 %). Mean abscess volume decreased from 18.8 cm³ preoperatively to 10.8 cm³ postoperatively, 4.4 cm³ at 4-12 weeks, and 2.2 cm³ at final follow-up. Edema volume declined from 53.4 cm³ to 35.8 cm³ postoperatively, 10.6 cm³ at 4-12 weeks, and 3.5 cm³ at last follow-up. Volume reduction patterns were similar across surgical approaches, and no significant volumetric differences were observed between pediatric and adult patients. Recurrence was unrelated to surgical modality.

All three surgical approaches achieved substantial and sustained reductions in abscess and edema volumes, with comparable neurological outcomes across age groups. Serial MRI volumetrics provide detailed insight into the temporal evolution of intracerebral abscesses and may inform postoperative monitoring and follow-up strategies for primary brain abscesses.