Riazur Rehman, Azmatullah Khattak, Mian Iftiharul Huq, Mewat Shah, Mushtaq.
Management of brain abscesses.
J Surg Pak Jan ;17(4):152-5.

Objective: To find the etiology and outcome of treatment of brain abscesses. Study design: Descriptive case series. Place & Duration of study: Department of Neurosurgery, Hayatabad Medical complex Peshawar, from October 2008 to January 2010. Methodology: This study was carried out on patients of brain abscesses of all ages and both genders. Patients having fungal brain abscess, amoebic brain abscess and tuberculous brain abscess were excluded. Brain abscess was diagnosed on contrast CT scan. Cases of early cerebritis were treated using parenteral antibiotics for six to eight weeks. Surgical treatment consisted of either burr hole aspiration with the help of brain cannula, re-aspiration or craniotomy and excision of abscess capsule. Therapeutic outcome was assessed with CT scan on follow up. Procedure related complications and mortality were also recorded. Results: A total of 73 patients were managed. The commonest age group was from 11-20 year. The mean age was 26.36 ± 14.1 year (range - 0.16 - 67 year). There were 46 (63.01%) male and 27 (36.99%) female patients. The majority of brain abscesses were supratentorial (n=65 - 89.04%). In 8 (11.96%) cases abscess was in infratentorial region. Contiguous focus of infection was responsible for brain abscess in 29 (39.72%) patients, Majority of patients presented with headache (n=30 - 41.09%) and vomiting (n=25 - 34.24%). Surgical drainage was performed in 70 (95.89%) patients where as 3 (4.11%) patients were treated conservatively. Initially only burr hole aspiration was done in all surgically treated patients. In 60 (85.71%) patients there was complete resolution. Craniotomy was done in 4 (5.71%) cases. There was no mortality in this study. Sixty one (87.14%) patients recovered without complications. Conclusions: Majority of the cases needed surgical intervention. Burr hole aspiration was effective initial surgical treatment. Cases of early cerebritis successfully managed with broad spectrum antibiotics.

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