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Original Article

Brain abscess: surgical experiences of 162 cases

Forhad Hossain Chowdhury , Md Raziul Haque , Mainul Haque Sarkar , S. M. Noman Khaled Chowdhury ,
1
2
2
2
Zahed Hossain , Shisir Ranjan 3
2
1 Department of Neurosurgery, National Institute of Neurosciences and Hospital, Sher‑e‑Bangla Nagar, Dhaka 1207, Bangladesh.
2 Department of Neurosurgery, Dhaka Medical College, Dhaka 1000, Bangladesh.
3 Department of Neonatolgy, Dhaka Medical College, Dhaka 1000, Bangladesh.
ABSTRA CT
Aim: Brain abscess still poses a public health challenge in spite of the advent of modern neurosurgical techniques and antibiotics.
Here, we present our surgical experiences and ultimate outcome in the management of brain abscess. Methods: Totally, 162 patients
with proved brain abscess who underwent surgical treatment were included in this study. The prospectively recorded data of surgical
management of brain abscess and the ultimate outcome (by Glasgow outcome scale) were studied retrospectively. Results: Total
number of cases was 162, of which 113 were acute pyogenic abscess while 49 were chronic abscess. Among the chronic abscess,
29 were chronic pyogenic abscess, 14 were tubercular, 3 aspergillus, and 3 abscesses were in malignant brain metastases. 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. Seventy‑three (45.06%) patients had adjacent localized
sinus, middle ear or cranial infection. The common predisposing factors included postneurosurgery, postpenetrating injury to brain,
chronic suppurative otitis media, and congenital heart disease, infective endocarditis, sinusitis and sub optimum immuno‑status.
Frontal lobe involved in 30.2% cases, temporal lobe is next to involved. Single time burr hole aspiration in 111 (68.5%) cases, two
or more times burr hole aspiration were done in 34 (21%) cases. Pus culture was negative in 129 (79.62%) cases. Total number
of death was 22 (13.58%) cases. Complete resolution of abscess with complete recovery of preoperative neuro‑deficit was seen
in 80.86% cases and recovery with major neuro‑deficit was observed in 5.55% cases. There is a significant association between
Glasgow coma scale (GCS) on admission and mortality in brain abscess. Conclusion: In most of the cases, pus culture did not
yield growth of any causative organism. Mortality was not directly related to surgical intervention, but GCS on admission has a
significant association with mortality. Early diagnosis, optimum follow‑up and timely surgical interventions are the keys in the proper
management of brain abscess.
Key words: Acute and chronic brain abscess, brain abscess, outcome, surgical management

INTRODUCTION Here, we report our experiences including preoperative
clinical features, radio-imaging findings, surgical
Brain abscesses often occur in the developed world, interventions, postoperative course, complications,
and they are even more common in developing risk factors and causes, infectious agent and ultimate
countries. In spite of the advent of modern outcome in the management of brain abscess.
[1]
neurosurgical techniques, including stereotactic brain
biopsy and aspiration, better culturing techniques METHODS
to identify the infectious agent, new antibiotics,
and modern noninvasive neuroimaging procedures, Totally, 162 patients with proved (peroperative and
brain abscess still poses a public health challenge, postoperative) brain abscess who underwent surgical
especially in developing countries. [2,3] There are treatment in the Department of Neurosurgery, Mitford
enormous diagnostic and therapeutic challenges and Hospital, Dhaka Medical College Hospital, and some
private hospitals (Ibn Sina specialized hospital, popular
controversies in the management of brain abscess.
specialized hospital, Islami Bank Central Hospital and
Pan Pacific Hospital) in Dhaka, Bangladesh, from July
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1999 to June 2013, were included in this study. The
Quick Response Code: local review board in Dhaka approved this study. The
Website:
www.nnjournal.net prospectively recorded data of clinical presentation,
neurological status at admission, radiological imaging,
DOI: predisposing factors, anatomical location, number of
10.4103/2347-8659.160851 lesions, surgical techniques, complications, cultured
organisms, and the neurological outcome were

Corresponding Author: Dr. Forhad Hossain Chowdhury, Department of Neurosurgery, National Institute of Neurosciences and
Hospital, Shahid Shahabuddin Shorok, Sher‑e‑Bangla Nagar, Dhaka 1207, Bangladesh. E‑mail: forhadchowdhury74@yahoo.com

PB Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 153