Brain abscess management: A decade of experience

Brain abscess remains a significant neurosurgical challenge, particularly in low- and middle-income countries, despite advances in neuroimaging, microbiological diagnostics, and surgical techniques. Optimal management requires a combination of timely diagnosis, appropriate antimicrobial therapy, and judicious surgical intervention.

This retrospective single-center study analyzed 59 patients who underwent surgical management for intracranial brain abscesses over 10 years (January 2015-December 2024). Demographic characteristics, clinical presentation, predisposing factors, radiological features, microbiological profile, surgical modality, and outcomes were evaluated. Neurological status at admission was assessed using the Glasgow Coma Scale, and outcomes were measured at 6 months using the Glasgow Outcome Scale (GOS). Outcomes were categorized as favorable (GOS 4-5) or unfavorable (GOS 1-3).

The majority of patients were male (72.9%), with a mean age higher in the unfavorable outcome group. Single abscesses were observed in 48 patients (81.4%). The frontal lobe was the most common location (30.5%), followed by the temporal (23.7%) and cerebellar (13.6%) lobes. Headache (72.9%), fever (52.5%), seizures (50.8%), and focal neurological deficits (44.1%) were the predominant presenting symptoms. No identifiable predisposing factor was found in 50.8% of cases, whereas post-traumatic etiology was the most common identifiable cause (16.9%). Microbiological cultures were positive in 27 patients (45.8%), with Streptococcus species being the most frequently isolated organisms; cultures were negative in 54.2% of cases. Image-guided aspiration was performed in 57.6% of patients, whereas craniotomy and excision were required in 37.3%. Favorable outcomes were achieved in 53 patients (89.8%), with an overall mortality rate of 10.2%. Poor outcomes were significantly associated with immunosuppression and the presence of multiple abscesses.

A combined medical and surgical approach yields favorable outcomes in the majority of patients with brain abscess. Image-guided aspiration is an effective first-line surgical modality in appropriately selected cases, whereas craniotomy and excision remain essential for complex or refractory lesions. Early diagnosis, prompt antimicrobial therapy, and timely surgical intervention are critical determinants of outcome.