Temporal lobe brain abscess: Etiology, microbiology, surgical management, and outcomes - A systematic review

Temporal lobe brain abscess is an uncommon but clinically significant intracranial infection most frequently associated with otogenic disease. Although brain abscess has been widely studied, location-specific analyses focusing on the temporal lobe remain limited. This systematic review aimed to evaluate the etiology, microbiology, surgical management, and outcomes of temporal lobe brain abscess reported in the literature.

A systematic literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar to identify studies reporting temporal lobe brain abscess. Eligible studies included case reports and case series with extractable clinical data. Data were extracted regarding demographics, predisposing factors, microbiological findings, abscess characteristics, treatment strategies, and clinical outcomes. Risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions for case series and the Joanna Briggs Institute checklist for case reports. Descriptive analysis was performed for the overall cohort, and pooled estimates were calculated for variables with sufficient data.

Forty studies, including 105 patients, were reviewed, but incomplete reporting limited the pooled analysis to 60 patients. Men comprised 64.76% (35/60), with a pooled proportion of 0.588 (95% confidence interval [CI]: 0.474-0.702; I² = 0%). Otogenic infection was present in 47.62% (33/60), with a pooled proportion of 0.707 (95% CI: 0.073-1.340; I² = 98.35%). Positive microbiological cultures were found in 65.71% (33/60), yielding a pooled proportion of 0.539 (95% CI: 0.421-0.656; I² = 4.09%). Aspiration was performed in 73.33% of cases, while both craniotomy and mastoidectomy were each used in 26.67%. A good neurological outcome was seen in 84.76% (50/60), with a pooled estimate of 0.843 (95% CI: 0.738-0.949; I² = 17.17%). Mortality was 11.43% (7/60), with a pooled estimate of 0.126 (95% CI: -0.065-0.318; I² = 75.09%), and no recurrences were reported.

Temporal lobe brain abscess most commonly arises from otogenic infection and demonstrates a heterogeneous microbiological profile. Minimally invasive aspiration techniques represent the predominant surgical strategy, while open surgical approaches are reserved for complex cases. Early diagnosis, appropriate antimicrobial therapy, and timely surgical management remain essential for optimizing patient outcomes.