[Current therapeutic orientation in intracranial suppuration].

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Context:

• Intracranial infections pose significant diagnostic and management challenges.
• A continuous series of 102 cases from 1968 to 1980 were analyzed to assess changes in diagnosis and management.
• The study period encompassed the introduction and increasing use of computed tomography (CT) scans.

Purpose:

• To evaluate the impact of computed tomography (CT) scans on the diagnosis and management of intracranial infections.
• To assess the influence of improved bacteriological studies on treatment outcomes.
• To determine changes in surgical approaches for intracranial abscesses.

Summary:

• Computed tomography (CT) scans increased the detection of intracranial infections in the very acute phase (before day 2) but did not alter the overall acute phase diagnosis rate or neurological status.
• Bacteriological studies, particularly after the establishment of a dedicated laboratory in 1976, led to a decrease in sterile cultures, an increase in identified pathogens (including anaerobes), and a reduction in mortality and sequelae.
• The combination of CT imaging and enhanced bacteriological data facilitated a simplified surgical strategy for brain abscesses, emphasizing CT-guided puncture and antibiotic therapy tailored to identified organisms.

Impact:

• The integration of CT scans and advanced bacteriology has refined the diagnostic accuracy and therapeutic efficacy for intracranial infections.
• Simplified surgical management, including early CT-guided puncture and targeted antibiotic selection, has improved patient outcomes.
• Reduced mortality and sequelae rates underscore the significance of these advancements in neurosurgical care.