Robot-Assisted Incision and Drainage for a Polymicrobial Brain Abscess

To evaluate the clinical utility of robot-assisted incision and drainage in the management of a polymicrobial brain abscess located in the central region.

We retrospectively analyzed a case of polymicrobial odontogenic brain abscess in a 71-year-old male who presented with stroke-like symptoms. The patient was admitted due to progressive right-sided weakness, initially mimicking an acute ischemic stroke. Gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) revealed ring-enhancing lesions in the left precentral gyrus and the right temporal lobe, with corresponding high signal on diffusion-weighted imaging (DWI), highly suggestive of a brain abscess. Following empirical antibiotic therapy (vancomycin and meropenem), the patient clinically deteriorated, and a repeat MRI demonstrated enlargement of the left central abscess. During the Remebot robotic navigation, the abscess was incised and drained, yielding thick, yellowish-white purulent material. Postoperative metagenomic next-generation sequencing (mNGS) of the pus identified a polymicrobial infection comprising Fusobacterium nucleatum, Streptococcus constellatus, Parvimonas micra, and Porphyromonas gingivalis.

Based on the microbiological findings, the antibiotic regimen was tailored to a triple combination of vancomycin, meropenem, and metronidazole for 2 weeks, followed by vancomycin plus meropenem for an additional 4 weeks, complemented by rehabilitation and hyperbaric oxygen therapy. The patient demonstrated remarkable neurological recovery. One month post-surgery, right limb muscle strength had returned to grade 5, with only mild residual impairment in fine-motor coordination of the right hand. Three-month follow-up MRI revealed complete resolution of the previously observed intracranial ring-enhancing lesions.

For eloquent-area brain abscesses that progress despite medical management, robot-assisted incision and drainage offers a safe, precise, and efficacious minimally invasive surgical option. Integration of mNGS technology for pathogen identification enables targeted antimicrobial therapy, a pivotal step toward achieving favorable outcomes in complex infections.