Brain abscess surgery

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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

The decision to drain the tumor surgically vs. aspiration is based on the number of abscesses, their size, and their location in the brain.

=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 <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 Abscess

  • 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.

References

  1. 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.
  2. 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)