Robot-Assisted Incision and Drainage for a Polymicrobial Brain Abscess.

Area of Science:

• Neurosurgery
• Infectious Diseases
• Medical Robotics

Background:

• Brain abscesses in eloquent areas pose significant management challenges.
• Polymicrobial infections complicate treatment, often requiring advanced diagnostic and surgical approaches.
• Failure of empirical antibiotic therapy necessitates alternative interventions.

Purpose of the Study:

• To assess the clinical utility of robot-assisted incision and drainage for a complex brain abscess.
• To evaluate the role of metagenomic next-generation sequencing (mNGS) in guiding antimicrobial therapy.
• To report the outcomes of minimally invasive surgery for an eloquent-area brain abscess.

Main Methods:

• Retrospective analysis of a single case involving a 71-year-old male with a polymicrobial brain abscess.
• Robot-assisted (Remebot) navigation for precise abscess incision and drainage.
• Postoperative mNGS of purulent material for pathogen identification.
• Tailored antibiotic therapy based on mNGS results, supplemented with rehabilitation and hyperbaric oxygen therapy.

Main Results:

• mNGS identified a polymicrobial infection including Fusobacterium nucleatum, Streptococcus constellatus, Parvimonas micra, and Porphyromonas gingivalis.
• Robot-assisted drainage yielded thick purulent material.
• Neurological recovery was significant, with return to grade 5 muscle strength and mild residual fine-motor impairment.
• Follow-up MRI at three months showed complete resolution of intracranial ring-enhancing lesions.

Conclusions:

• Robot-assisted incision and drainage is a safe, precise, and effective minimally invasive option for eloquent-area brain abscesses progressing despite medical management.
• mNGS-guided targeted antimicrobial therapy is crucial for favorable outcomes in complex brain abscess infections.
• This approach offers a valuable alternative for challenging neurosurgical cases.