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Intracranial Pressure Monitoring In Nontraumatic Intraventricular Hemorrhage Rodent Model
Published on: February 8, 2022
Intraventricular rupture of brain abscess: A two-center observational cohort study
Dimitri T K Ndandja1, Gennady E Chmutin1, Gerald Musa2
1Department of Neurosurgery and Neurological Sciences, People's Friendship University of Russia named after Patrice Lumumba, Moscow, Russian Federation.
Background:
Intraventricular rupture of brain abscess (IVROBA) remains one of the most devastating complications of bacterial brain abscess, historically associated with high mortality rates. Early identification of measurable predictors of rupture is essential for timely intervention and improved prognosis.
Methods:
We analyzed a combined retrospective-prospective cohort of 104 patients treated for brain abscesses at two tertiary Moscow hospitals (2018-2023). Demographic, clinical, and radiological variables were assessed. Microbiological profiles, management strategies, and outcomes were evaluated. Logistic regression and receiver operating characteristic (ROC) analyses determined predictors of IVROBA and unfavorable outcomes.
Results:
IVROBA occurred in 28 patients (26.9%), representing the strongest independent predictor of mortality (adjusted odds ratio [aOR] = 14.2, p < 0.001) and poor outcome (Glasgow outcome scale 1-4). Multivariate analysis confirmed minimal distance between the abscess capsule and the ventricular wall as the predominant risk factor. Abscesses within 0-2 mm, 2-5 mm, and 5-10 mm of the ventricles had progressively higher adjusted odds of rupture (aOR = 87.2, 48.6, and 8.1, respectively; all p < 0.05) compared with those >10 mm away. Immunodeficiency was an additional independent risk factor (aOR = 9.7, p = 0.049). ROC analysis identified ≤5 mm as the optimal cutoff (area under the curve = 0.872; sensitivity 84.6%, specificity 81.2%).
Conclusion:
Proximity to the ventricular system is the principal mechanical determinant of intraventricular rupture, surpassing other clinical and radiologic variables. Abscesses within 5 mm of the ventricle should be managed aggressively, favoring early surgical drainage to prevent fatal rupture and ventriculitis.
Insights
Intraventricular rupture of brain abscesses is a severe complication. Abscesses within 5 mm of the ventricle are at high risk, necessitating aggressive management like early surgical drainage.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Radiology
Background:
- Intraventricular rupture of brain abscess (IVROBA) is a critical complication with high mortality.
- Identifying predictors of IVROBA is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To identify measurable predictors of intraventricular rupture of brain abscess (IVROBA).
- To determine the association between abscess proximity to the ventricular wall and rupture risk.
- To evaluate the role of immunodeficiency as a risk factor for IVROBA.
Main Methods:
- Analysis of a combined retrospective-prospective cohort of 104 patients with brain abscess.
- Logistic regression and receiver operating characteristic (ROC) analyses to identify predictors of IVROBA and unfavorable outcomes.
- Assessment of demographic, clinical, radiological, and microbiological variables.
Main Results:
- IVROBA occurred in 26.9% of patients and was the strongest predictor of mortality (aOR=14.2).
- Minimal distance between the abscess capsule and the ventricular wall was the predominant risk factor, with rupture odds increasing significantly as distance decreased (≤5 mm: aOR=48.6).
- Immunodeficiency (aOR=9.7) was an additional independent risk factor. ROC analysis identified ≤5 mm as the optimal cutoff for rupture risk (AUC=0.872).
Conclusions:
- Abscess proximity to the ventricular system is the primary mechanical determinant of intraventricular rupture.
- Brain abscesses within 5 mm of the ventricle require aggressive management, including early surgical drainage, to prevent rupture and ventriculitis.
- Early identification of high-risk abscesses based on ventricular proximity can guide timely intervention and improve prognosis.
