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Baseline Brain Abscess Volume as a Predictor of Repeat Surgery: A Prospective Cohort Study
Musawer Khan1, Muhammad Naveed Khan1, Waseem Sajjad1
1Department of Neurosurgery, Medical Teaching Institution/Mardan Medical Complex, Mardan, Pakistan.
Objective:
To evaluate whether baseline brain abscess volume predicts the need for repeat surgical intervention within 90 days after the index procedure.
Study Design:
An observational study. Place and Duration of the Study: Department of Neurosurgery, Medical Teaching Institution/Mardan Medical Complex, Mardan, Pakistan, from January 2024 to September 2025.
Methodology:
Consecutive patients with a brain abscess confirmed by contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) who underwent surgical intervention and completed at least 90 days of follow-up were included. Patients with epidural or subdural empyema, fungal or tuberculous abscesses, and those managed non-surgically were excluded. Baseline abscess volume was estimated using the ellipsoid (ABC/2) method on contrast-enhanced imaging. The primary outcome was repeat surgical intervention within 90 days of the index surgery. Baseline abscess volume was compared between the groups, and logistic regression and receiver operating characteristic (ROC) analyses were performed.
Results:
Fifty-three patients (mean age 28.9 ± 17.9 years; 64.2% male) were included. Fourteen patients (26.4%) required repeat surgical intervention within 90 days. Baseline abscess volume was significantly higher in patients requiring re-intervention compared with those who did not (28.55 ± 7.03 cm3 versus 21.18 ± 8.06 cm3, p = 0.004). In univariable logistic regression, the odds ratio (OR) for baseline volume was 1.128 per cm3; the 95% confidence interval (CI) was 1.032-1.234 (p = 0.008). ROC analysis demonstrated acceptable discrimination, with an area under the curve (AUC) of 0.752.
Conclusion:
Larger baseline brain abscess volume was associated with an increased likelihood of repeat surgical intervention within 90 days. Baseline abscess volume may serve as a useful adjunct for early risk stratification; however, larger multicentre studies are required for validation.
Key Words:
Brain abscess, Abscess volume, Neurosurgery, Repeat surgery, Prognosis.
