Surgical Outcome of Brain Abscess after Single Burrhole Aspiration Technique in Terms of Glasgow Outcome Scale

  • Alamgir Khan Department of Neurosurgery, Pakistan Air Force (PAF) Hospital
  • Fayyaz Ahmad Hayatabad Medical Complex (HMC), Peshawar
  • Ehsan-ur- Rehman Pakistan Institute of Medical Sciences (PIMS) Hospital
Keywords: Brain abscess, Surgical Outcome, Burrhole Aspiration, Glasgow outcome scale

Abstract

Objectives:  This case-series was aimed to determine the surgical outcome of brain abscess after a single burr hole aspiration technique in terms of the Glasgow outcome scale (GOS).

Material & Methods:   100 cases were taken in the study with brain abscess. The favourable outcome included those patients with postoperative GOS of 4 or 5, at discharge and one month postoperatively whereas unfavourable outcome included patients with postoperative GOS of less than 4, at discharge and one month postoperatively.

Results:  Of the 100 patients included, there were 72 (72%) males and 28 (28%) females. The overall mean diameter of the abscess was 6.01 cm ± 1.90. Mean GOS was 2.95 ± 0.86 while mean GOS 3.79 ± 1.18. In this study 75% (n=75) patients presented with a GCS of 12 or less. Among these patients, 2 patients presented with a GCS of 5, 6 patients with a GCS of 7, 9 with GCS 8, 11 with GCS 9, 18 with GCS 10, 15 with GCS 11 and 14 patients presented with a GCS of 12. A favourable outcome was observed in 73 (73%) patients (GOS = 4 and 5), while 27 (27%) were in the unfavourable outcome group.

Conclusion:  Although most of the patients present with a good neurological state, those who present with lower GCS are particularly prone to the poor postoperative outcome and higher mortality. The size of the brain abscess is also an important predictor of the postoperative outcome. The overall outcome for brain abscess aspiration was good.

References

1. Tunkel AR SW. Brain Abscess. In: HR W, editor. Youmans neurological surgery. 6thy ed. Philadelphia: Elsevier, 2011: p. 588.
2. Zhang C HL, Wu X, Hu G, Ding X, Lu Y. A retrospective study on the aetiology, management, and outcome of brain abscess in an 11-year, a single-centre study from China. BMC Infect Dis. 2014; 14: 311.
3. Hussain A KA. Frequency of intracranial complications in chronic otitis media. J Ayub Med Coll Abbottabad, 2005; 17 (1): 75-7.
4. Khan A KM, Muhammad. Intracranial complications of chronic suppurative otitis media: clinical presentation and outcome of surgical procedures. Gomal J Med Sci. 2012; 10: 186-9.
5. Mehnaz A, Syed AU, Saleem AS, Khalid CN. Clinical features and outcome of cerebral abscess in congenital heart disease. J Ayub Med Coll Abbottabad, 2006; 18 (2): 21-4.
6. Qureshi H, Habib A, Siddiqui A, Mozaffar T, Sarwari A. Predictors of mortality in brain abscess. J Pak Med Assoc. 2002; 52 (3): 111-6.
7. Ersin E TC. Pyogenic brain abscess. Neurosurg Focus, 2008; 24 (E2): 1-10.
8. Rath TJ, Hughes M, Arabi M, Shah GV. Imaging of cerebritis, encephalitis, and brain abscess. Neuroimaging Clin N Am. 2012; 22 (4): 585-607.
9. D S. Management of brain abscesses. II: Antibiotics and computed tomography. J Clin Neurosci. 2013; 20 (12): 1675-81.
10. D S. Management of brain abscesses. I: Drainage and antiseptics. J Clin Neurosci. 2013; 20 (12): 1669-74.
11. LU CH, Chang WN, LIN YC, Tsai NW, Liliang PC, Su TM, et al. Bacterial brain abscess: microbiological features, epidemiological trends and therapeutic outcomes. QJM. 2002; 95 (8): 501-9.
12. Sarmast AH, Showkat HI, Kirmani AR, Bhat AR, Patloo AM, Ahmad SR, et al. Aspiration versus excision: a single center experience of forty-seven patients with brain abscess over 10 years. Neurol Med Chir. 2012; 52 (10): 724-30.
13. Aras Y, Sabanci PA, Izgi N, Boyali O, Ozturk O, Aydoseli A, et al. Surgery for Pyogenic Brain Abscess over 30 Years: Evaluation of the Roles of Aspiration and Craniotomy. Turk Neurosurg. 2016; 26 (1): 39-47.
14. Arora K, Dawkins RL, Bauer DF, Palmer CA, Hackney JR, Markert JM. Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery. Surg Neurol Int. 2015; 6: 174.
15. Atiq M, Ahmed US, Allana SS, Chishti KN. Brain abscess in children. Indian J Pediatr. 2006; 73 (5): 401-4.
16. Bajpai A, Prasad KN, Mishra P, Gupta RK, Singh AK, Ojha BK. Multimodal approach for diagnosis of bacterial etiology in brain abscess. Magn Reson Imaging, 2014; 32 (5): 491-6.
17. Ballantine HT, Jr., Shealy CN. The role of radical surgery in the treatment of abscess of the brain. Surg Gynecol Obstet. 1959; 109: 370-4.
18. Shachor-Meyouhas Y, Bar-Joseph G, Guilburd JN, Lorber A, Hadash A, Kassis I. Brain abscess in children - epidemiology, predisposing factors and management in the modern medicine era. Acta Paediatr. 2010; 99 (8): 1163-7.
19. Auvichayapat N, Auvichayapat P, Aungwarawong S. Brain abscess in infants and children: a retrospective study of 107 patients in northeast Thailand. J Med Assoc Thai. 2007; 90 (8): 1601-7.
20. Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children's Hospital Boston. Pediatrics, 2004; 113 (6): 1765-70.
21. Clinical nuclear Medicine Curr Treat Options Neurol. Radoi M, Ciubotaru V, Tataranu L. Brain abscesses: clinical experience and outcome of 52 consecutive cases. Chirurgia (Bucur). 2013; 108 (2): 215-25.
22. Zhang C, Hu L, Wu X, Hu G, Ding X, Lu Y. A retrospective study on the aetiology, management, and outcome of brain abscess in an 11-year, single-centre study from China. BMC Infect Dis. 2014; 14: 311.
23. Abdullah J. Clinical presentation and outcome of brain abscess over the last 6 years in community based neurological service. J Clin Neurosci. 2001; 8 (1): 18-22.
24. Qureshi HU, Habib AA, Siddiqui AA, Mozaffar T, Sarwari AR. Predictors of mortality in brain abscess. J Pak Med Assoc. 2002; 52 (3): 111-6.
25. Hsiao SY, Chang WN, Lin WC, Tsai NW, Huang CR, Wang HC, et al. The experiences of non-operative treatment in patients with bacterial brain abscess. Clin Microbiol Infect. 2011; 17 (4): 615-20.
26. Sarmast AH SH, Kirmani AR, Bhat AR, Patloo AM, Ahmad SR. Aspiration vs excision: A single centre experience of forty-seven patients with brain abscess over 10 years. Neurol Med Chir (Tokyo), 2012; 52: 724-30.
27. Ratnaike TE, Das S, Gregson BA, Mendelow AD. A review of brain abscess surgical treatment--78 years: aspiration versus excision. World Neurosurg. 2011; 76 (5): 431-6.
28. Aurangzeb A, Khan SA, Ahmed E, Mehmood S, Ali A, Zadran KK, et al. Predisposing factors, clinical presentation and outcome of repeated aspiration in cerebral abscess through a drainage tube in situ. J Ayub Med Coll Abbottabad, 2011; 23 (4): 58-60.
29. Nathoo N, Nadvi SS, Narotam PK, van Dellen JR. Brain abscess: management and outcome analysis of a computed tomography era experience with 973 patients. World Neurosurg. 2011; 75 (5-6): 716-26; Discussion 612-7.
Published
2021-09-30
Section
Original Articles