Brain abscess surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Sterotactic aspiration of the brain abscess should be performed with the intention of identification of the causative pathogen and decompression in the absence of contraindications. An abscess measures at least 2.5 cm in diameter has been recommended as an indication for intervention; however, with contemporary neurosurgical techniques, almost any brain abscess greater than 1 cm in diameter is amenable to aspiration regardless of location.[1][2]
Surgery
Surgery has evolved dramatically over the last few decades. Once requiring open craniotomy and drainage / excision, most procedures are currently minimally invasive, closed, and performed under local anesthesia with conscious sedation and CT guidance.
- CT guidance is accurate to within 4 – 5 mm.
- Stereotactic drainage can also be used if necessary, and is accurate to within 1 – 2 mm.
- Open craniotomy with complete excision is usually reserved for patients with multiloculated abscesses or in cases due to more resistant pathogens (e.g. fungi and nocardia).
References
- ↑ Brouwer, Matthijs C.; Tunkel, Allan R.; McKhann, Guy M.; van de Beek, Diederik (2014-07-31). "Brain abscess". The New England Journal of Medicine. 371 (5): 447–456. doi:10.1056/NEJMra1301635. ISSN 1533-4406. PMID 25075836.
- ↑ Mamelak, A. N.; Mampalam, T. J.; Obana, W. G.; Rosenblum, M. L. (1995-01). "Improved management of multiple brain abscesses: a combined surgical and medical approach". Neurosurgery. 36 (1): 76–85, discussion 85-86. ISSN 0148-396X. PMID 7708172. Check date values in:
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