Analysis on Surgical Outcome of Brain Abscess.

Jeon, Sang Ryong; Kim, Jeong Hoon; Ra, Young Shin; Roh, Sung Woo; Kim, Chang Jin; Kwon, Yang; Lee, Jung Kyo; Rhim, Seung Chul; Kwun, Byung Duk

Original Article

Journal of Korean Neurosurgical Society 1999;28(8): 1131-1136.

Sang Ryong Jeon, Jeong Hoon Kim, Young Shin Ra, Sung Woo Roh, Chang Jin Kim, Yang Kwon, Jung Kyo Lee, Seung Chul Rhim, Byung Duk Kwun

Department of Neurological surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

ABSTRACT

OBJECTIVE
This study was undertaken to review the mortality, complications, risk factors and the surgical outcome in long-term follow-up cases of brain abscess.
METHODS
The authors studied medical records and radiological findings in patients with brain abscess who underwent operations in our hospital from 1990 to 1997.
RESULTS
There were 44 cases and the ratio of male to female was 32:12 which shows predominance in male. The ages of patients ranged from 2 to 73(average: 40). Lesions were located at frontal lobe in 16 cases, temporal in 8, parietal in 7, occipital in 5, cerebellum in 6, and multiple in 2. The ranges of follow-up periods were from 1 month to 96 months(average: 20.5 months). The primary origins of infection were found in only 15 cases(34%) and in 32 cases(73%), the organisms were identified from culture. The operative modalities were as follows; abscess aspiration (stereotactic or sono-guided) in 42 times and abscess excision in 13 times. There were 2 operations in 7 cases and 3 in 2 cases. In 2 cases, recurrences were occurred during antibiotics therapy after first operation. Three patients(6.8%) died due to sepsis in 2 cases, increased intracranial pressure in 1 case. We analysed 19 cases who were followed-up more than 12 months. In this group, there were intermittent seizures in 2 cases, antibiotics(metronidazole) induced polyneuropathy in 1 case, and avascular necrosis of hip in 2 cases which were suspected to have relation to long-term high dose steroid therapy. But there were no other sequalae or neurological deficits.
CONCLUSION
The complication rate from long-term follow-up was high(26%) but the mortality rate was low(6.8%). Additionally, the findings such as multiple lesions, empyema, and fungal infection are suspected to be risk factors in mortality cases.

Key Words: Brain abscess; Complication; Empyema; Fungal infection; Stereotactic aspiration