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Robot-Assisted Incision and Drainage for a Polymicrobial Brain Abscess
Chun Gui1,2,3, Jiajia Li4, Qiqi Wang2,3,5
1Departments of Emergency, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology.
Objective:
To evaluate the clinical utility of robot-assisted incision and drainage in the management of a polymicrobial brain abscess located in the central region.
Methods:
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.
Results:
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.
Conclusion:
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.
Insights
Robot-assisted surgery precisely drained a polymicrobial brain abscess in an eloquent area. Metagenomic sequencing guided targeted antibiotics, leading to significant neurological recovery and lesion resolution.
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.
