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Supratentorial and infratentorial brain abscesses: surgical treatment, complications and outcomes—a 10-year single-center study

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Abstract

Objective

To analyze the variables determining morbidity, mortality and outcome in subjects with brain abscesses treated at a single center over a 10-year period.

Methods

A retrospective study was conducted on a series of 59 patients with brain abscesses surgically treated with stereotactically guided aspiration or open craniotomy excision. Such variables as age, gender, clinical presentation, number of days to diagnosis, location, number of lesions, predisposing factors, mechanism of infection, etiological agent, and therapy were analyzed independently. Complications were defined as any deviation from the normal postoperative course occurring within 30 days of surgery, and classified according to a four-point gradual severity scale. Postoperative outcome was appraised through the Glasgow Outcome Scale (GOS) 6 months after surgery, 0–4 points were considered poor outcome and 5 points good outcome.

Results

Eighty abscesses were diagnosed and surgically managed in 59 patients. The mean age was 44.69 years (range: 0.16-77); 59.3% were female. The median number of days to diagnosis was 7. Most frequent clinical presentations included fever (52.5%), headache (42.4%), and focal neurologic deficits (39%). Mechanism of infection was mainly hematogenous spread (32.2%). Stereotactically guided aspiration was the treatment of choice for 74.6% of the patients, whereas 25.4% of the cases were managed through open craniotomy excision. Outcome was favorable in 81.35% (n = 48) of the subjects. General morbidity was 27.1%, and mortality stood at 10.16%. Out of a total 38.98% (n = 23) of complications, two-thirds were due to medical causes. The analysis of variables revealed that only age (p = 0.02), immunosuppression (OR 5.83; p = 0.012) and hematogenous spread (p < 0.01) were associated with poor outcomes.

Conclusions

Immunosuppression, hematogenous spread and advanced age were predictors of poor prognosis. Most of the complications following brain abscess management were not directly related to surgery or surgical technique.

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Acknowledgments

We thank Omar Konsol M.D., Santiago Portillo M.D. and Carlos Ciraolo M.D. for their assistance with the manuscript preparation and pediatric patient’s data and images.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital Italiano de Buenos Aires, Sánchez de Bustamante 523 8°B, CP 1173 ABI, Buenos Aires, Argentina

    Federico Landriel, Pablo Ajler, Santiago Hem, Damian Bendersky, Ezequiel Goldschmidt, Lucas Garategui, Eduardo Vecchi & Antonio Carrizo

  2. Department of Pediatric Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Omar Konsol

Authors
  1. Federico Landriel
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  2. Pablo Ajler
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  3. Santiago Hem
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  4. Damian Bendersky
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  5. Ezequiel Goldschmidt
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  6. Lucas Garategui
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  7. Eduardo Vecchi
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  8. Omar Konsol
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  9. Antonio Carrizo
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Correspondence to Federico Landriel.

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Landriel, F., Ajler, P., Hem, S. et al. Supratentorial and infratentorial brain abscesses: surgical treatment, complications and outcomes—a 10-year single-center study. Acta Neurochir 154, 903–911 (2012). https://doi.org/10.1007/s00701-012-1299-z

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  • DOI: https://doi.org/10.1007/s00701-012-1299-z

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