Published: 2020-01-27

Clinical outcomes following surgical management of brain abscess in a tertiary care centre: retrospective analysis of 56 cases

V. V. Ramesh Chandra, B. C. M. Prasad, V. Niranjan, Nitin Manohar Barde


Background: Despite the advent of newer antibiotics and surgical strategies, the overall outcome and quality of life issues in Brain Abscess (BA) patients remain a continuous challenge for the neurosurgical community.

Methods: Fifty-six patients with BA are analyzed retrospectively, that treated between January 2014 and June 2019, according to age, the clinical symptoms, etiologic factors, infecting organisms, prognostic factors, localization, diagnostic and treatment methods and outcome.

Results: In acute cases, common clinical features were headache, fever, vomiting, focal deficit and seizure. In chronic abscesses, common clinical features were mild to moderate headache and progressive focal deficit. In 12(21.42%) patients had adjacent localized sinus, middle ear infection. In 27(48.21%) patients no primary source of infection was identified, predisposing factors included post neurosurgery (8.92%), post penetrating injury (3.57%), and congenital heart disease, infective endocarditis, sinusitis. The frontal lobe involved in 28.5% cases, temporal lobe and cerebellum are next to be involved. Burr hole aspiration in 29(51.78%) cases, a craniotomy was done in 15(26.78%) cases. Pus culture was negative in 36 (64.28%) cases. Mortality was noted in 2(3.57%) cases. Complete resolution of the abscess with complete recovery of preoperative neuro-deficit was seen in 71.42% cases and recovery with major neuro-deficit was observed in 16.07% cases. The best outcome was seen with a better Glasgow Coma Scale (GCS) on admission.

Conclusions: BA, when surgery is required, should be done on an emergency basis. BA treated with burr hole aspiration shows excellent clinical and radiological response. A craniotomy is required in selected cases and is a primary procedure in cerebellar, postoperative and posttraumatic abscesses. Broad-spectrum antibiotic therapy should be administered for a period of minimum 6 weeks to prevent relapse.


Brain abscess, Burr hole aspiration, Ring enhancing lesions of brain

Full Text:



Bernardini GL. Diagnosis and management of brain abscess and subdural empyema. Current Neurol Neurosci Rep. 2004 Dec 1;4(6):448-56.

Wilson HL, Kennedy KJ. Scedosporium apiospermum brain abscesses in an immunocompetent man with silicosis. Medi Mycol Case Rep. 2013 Jan 1;2:75-8.

Ansari MK, Jha S. Tuberculous brain abscess in an immunocompetent adolescent. J Natural Sci, Biol, Med. 2014 Jan;5(1):170.

Nathoo N, Narotam PK, Nadvi S, van Dellen JR. Taming an old enemy: a profile of intracranial suppuration. World Neurosurg. 2012 Mar 1;77(3-4):484-90.

Britt RH, Enzmann DR, Yeager AS. Neuropathological and computerized tomographic findings in experimental brain abscess. J Neurosurg. 1981 Oct 1;55(4):590-603.

Manzar N, Manzar B, Kumar R, Bari ME. The study of etiologic and demographic characteristics of intracranial brain abscess: a consecutive case series study from Pakistan. World Neurosurg. 2011 Jul 1;76(1-2):195-200.

Lai PH, Ho JT, Chen WL, Hsu SS, Wang JS, Pan HB, Yang CF. Brain abscess and necrotic brain tumor: discrimination with proton MR spectroscopy and diffusion-weighted imaging. Am J Neuroradiol. 2002 Sep 1;23(8):1369-77.

Sharma BS, Gupta SK, Khosla VK. Current concepts in the management of pyogenic brain abscess. Neurol Ind. 2000 Apr 1;48(2):105.

Rosenblum ML. Controversies in the management of brain abscess. Clin Neurosurg. 1986;33:603-32.

Keet PC. Cranial intradural abscess management of 641 patients during the 35 years from 1952 to 1986. Bri J Neurosurg. 1990 Jan 1;4(4):273-8.

Yang SY, Zhao CS. Review of 140 patients with brain abscess. Surg Neurol. 1993 Apr 1;39(4):290-6.

Moorthy RK, Rajshekhar V. Management of brain abscess: an overview. Neurosurg Focus. 2008 Jun 1;24(6):E3.

Prusty GK. Brain abscesses in cyanotic heart disease. Ind J Pediatr. 1993 Jan 1;60(1):43-51.

Joshi S, Devkota UP. The management of brain abscess in a developing country: are the results any different?. Bri J Neurosurg. 1998 Jan 1;12(4):325-8.

Livraghi S, Melancia JP, Antunes LL. The management of brain abscesses. Advan Technical Standards Neurosurg 2003;285-313.

Udoh DO, Ibadin E, Udoh MO. Intracranial abscesses: Retrospective analysis of 32 patients and review of literature. Asian J Neurosurg. 2016 Oct;11(4):384.

Hakan T, Ceran N, Erdem İ, Berkman MZ, Göktaş P. Bacterial brain abscesses: an evaluation of 96 cases. J Inf. 2006 May 1;52(5):359-66.

Tseng JH, Tseng MY. Brain abscess in 142 patients: factors influencing outcome and mortality. Surg Neurol. 2006 Jun 1;65(6):557-62.

Yoshikawa TT, Goodman SJ. Brain abscess Teaching Conference, University of California, Los Angeles, Harbor General Hospital, Torrance (Specialty Conference). West J Med. 1974;121:207 19.

Meis J, Groot-Loonen J, Korstanje JA. A brain abscess due to multiply-resistant Enterobacter cloacae Successfully treated with meropenem (letter). Clin Infect Dis. 1995;20(6):1567.

Singh N, Husain S. Infections of the central nervous system in transplant recipients. Transplant Inf Dis. 2000 Sep 1;2(3):101-11.

Renier D, Flandin C, Hirsch E, Hirsch JF. Brain abscesses in neonates: a study of 30 cases. J Neurosurg. 1988 Dec 1;69(6):877-82.

Glenn E. Mathisen, J. Patrick Johnson, Brain Abscess, Clin Inf Dis. 1997:25(4);763-79.

Muzumdar D, Jhawar S, Goel A. Brain abscess: an overview. Inter J Surg. 2011 Jan 1;9(2):136-44.

Unnikrishnan M, Chandy MJ, Abraham J. Posterior fossa abscesses. A review of 33 cases. J Assoc Phys Ind. 1989 Jun;37(6):376-8.

De Louvois, EM Brown, R. Bayston, PD Lees, IK Pople J. The rational use of antibiotics in the treatment of brain abscess. Bri J Neurosurg. 2000 Jan 1;14(6):525-30.

Hall WA, Truwit CL. The surgical management of infections involving the cerebrum. Neurosurg. 2008;62(2):519-30.

Tan WM, Adnan JS, Haspani MS. Treatment outcome of superficial cerebral abscess: An analysis of two surgical methods. Malaysian J Med Sci: MJMS. 2010 Jan;17(1):23.

Lee TH, Chang WN, Su TM, Chang HW, Lui CC, Ho JT, et al. Clinical features and predictive factors of intraventricular rupture in patients who have bacterial brain abscesses. J Neurol, Neurosurg Psychi. 2007 Mar 1;78(3):303-9.

Ramakrishnan KA, Levin M, Faust SN. Bacterial meningitis and brain abscess. Medicine. 2013 Dec 1;41(12):671-7.

Legg NJ, Gupta PC, Scott DF. Epilepsy following cerebral abscess a clinical and eeg study of 70 patients. Brain. 1973 Jun 1;96(2):259-68.

Arlotti M, Grossi P, Pea F, Tomei G, Vullo V, De Rosa FG, et al. Consensus document on controversial issues for the treatment of infections of the central nervous system: bacterial brain abscesses. Inter J Infe Dis. 2010 Oct 1;14:S79-92.

Radoi1 M, Ciubotaru V, Tataranu L. Brain Abscesses: Clinical Experience and Outcome of 52 Consecutive Cases Chirurgia. 2013;108:215-25.

Muzumdar D, Jhawar S, Goel A. Brain abscess: an overview. Inter J Surg. 2011 Jan 1;9(2):136-44.

Tonon E, Scotton PG, Gallucci M, Vaglia A. Brain abscess: clinical aspects of 100 patients. Inter J Infe Dis. 2006 Mar 1;10(2):103-9.

Takeshita M, Kagawa M, Yato S, Izawa M, Onda H, Takakura K, et al. Current treatment of brain abscess in patients with congenital cyanotic heart disease. Neurosurg. 1997 Dec 1;41(6):1270-8.