Brain abscess surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farwa Haideri [2]

Overview

Surgery is the mainstay of treatment for patients with brain abscesses if the size of the abscess exceed 2.5 cm in diameter. The decision to drain the tumor surgically vs. aspiration is based on the number of abscesses, their size, and their location in the brain. Sterotactic aspiration of the brain abscess is performed for identifying causative pathogens and decompressions in the absence of contraindications.^[1]^[2]

Surgery

The decision to drain the tumor surgically vs. aspiration is based on:^[1]^[2]

Size of Abscess

Smaller than 2.5 cm in diameter: Administer antimicrobial therapy only.
Larger than 2.5 cm in diameter: Drain (either surgically or by repeated aspirations) and administer antimicrobial therapy.

Number of Abscesses

Single brain abscess: A single brain abscess less than 2.5 cm in diameter are usually aspirated for culture and are not surgically drained.
Multiple brain abscesses: Repeated aspirations of multiple brain abscesses is preferred over surgical drainage.

Location of Abscesses

Regions of sensory or motor cortex: Aspiration is preferred over surgical drainage.
Speech region: Aspiration is preferred over surgical drainage.
Other regions: Either aspiration or surgical drainage.

With contemporary neurosurgical techniques, almost any brain abscess greater than 1 cm in diameter is amenable to aspiration regardless of location. Regardless of the approach to drain the abscess, administration of long-term antimicrobial therapy is always recommended among all patients who are suspected to have brain abscess. To view the list antimicrobial regimens, click here.

References

↑ ^1.0 ^1.1 Brouwer MC, Tunkel AR, McKhann GM, van de Beek D (2014). "Brain abscess". N Engl J Med. 371 (5): 447–56. doi:10.1056/NEJMra1301635. PMID 25075836.
↑ ^2.0 ^2.1 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: |date= (help)

[pmid25075836-1] 1.0 ^1.1 Brouwer MC, Tunkel AR, McKhann GM, van de Beek D (2014). "Brain abscess". N Engl J Med. 371 (5): 447–56. doi:10.1056/NEJMra1301635. PMID 25075836.

[bbb-2] 2.0 ^2.1 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: |date= (help)

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