Gas within intracranial abscess cavities: an indication for surgical excision

Five patients were treated in whom gas within an intracranial abscess cavity was identified by plain roentgenogram, computed tomographic scan, or both. Management by aspiration in three patients was unsuccessful. Total excision of the abscess cavity was eventually required in all five patients, and a persistent extracranial communication was identified and closed in each. One patient died secondary to transtentorial herniation and severe brainstem injury; the other four recovered fully. Although certain anaerobic organisms may produce gas in the absence of a communication to the outside of the body, such production is uncommon. Total surgical excision is recommended for gas-containing abscesses because it allows removal of the mass lesion and identification and closure of possible persistent extracorporal communication.