Twist Drill Aspiration of Pyogenic Brain Abscesses: Our Experience in 103 Cases

Abstract

Background Intracranial abscesses remain a significant health care problem in developing countries. Though potentially curable, brain abscess remains a diagnostic and therapeutic challenge. The effective treatment of intracranial abscess remains controversial. Various surgical procedures like drainage, aspiration, and excision have been advocated for the management of brain abscess with variable results. Aspiration is a rapid and safe procedure, especially with use of stereotactic techniques, intraoperative ultrasound, or computed tomography (CT) scan guidance. However, these are not readily available everywhere.

Objective To assess the outcome in pyogenic brain abscesses treated by twist drill aspiration (a bedside procedure) in which point of aspiration is marked with the help of three-dimensional (3D) reconstructed CT images.

Methods From September 2007 to September 2011, a total of 103 cases of brain abscesses over 2.5 cm in size were treated by twist drill aspiration. The point of aspiration was marked with the help of 3D reconstructed CT images using fixed bony landmarks as reference, and exact measurement were taken with the help of biopsy software.

Results In the present study, 103 cases of superficial brain abscesses were treated via twist drill aspiration. Out of these, 98 patients had a single abscess and five had multiple abscesses. Out of the 103 patients, 86 (83.4%) showed good recovery, 9 (8.7%) had moderate disability, 3 (2.9%) had severe disability, and 5 (4.8%) expired.

Conclusion Twist drill aspiration is a rapid, safe, and very effective lifesaving procedure in the underdeveloped world where stereotaxy is not readily available.

Keywords

brain abscess - twist drill aspiration - minimally invasive technique

• References

• 1 Sharma BS, Gupta SK, Khosla VK. Current concepts in the management of pyogenic brain abscess. Neurol India 2000; 48 (2) 105-111
• 2 Rosenblum ML, Mampalam TJ, Pons VG. Controversies in the management of brain abscesses. Clin Neurosurg 1986; 33: 603-632
• 3 Sarma S, Sekhar LN. Brain-stem abscess successfully treated by microsurgical drainage: a case report. Neurol Res 2001; 23 (8) 855-861
• 4 Ozkaya S, Bezircioglu H, Sucu HK, Ozdemir I. Combined approach for otogenic brain abscess. Neurol Med Chir (Tokyo) 2005; 45 (2) 82-85 , discussion 86
• 5 Loftus CM, Osenbach RK, Billar J. Diagnosis and management of brain abscess. In: Wilkins RH, Rengachary SS, , eds. Neurosurgery. 2nd ed. New York: McGraw-Hill; 1996: 3285-3298
• 6 Srinivasan US, Gajendran R, Joseph MJ. Pyogenic brain abscess managed by repeated elective aspiration. Neurol India 1999; 47 (3) 202-205
• 7 Boviatsis EJ, Kouyialis AT, Stranjalis G, Korfias S, Sakas DE. CT-guided stereotactic aspiration of brain abscesses. Neurosurg Rev 2003; 26 (3) 206-209
• 8 Kutlay M, Colak A, Yildiz S, Demircan N, Akin ON. Stereotactic aspiration and antibiotic treatment combined with hyperbaric oxygen therapy in the management of bacterial brain abscesses. Neurosurgery 2005; 57 (6) 1140-1146 , discussion 1140–1146
• 9 Duma CM, Kondziolka D, Lunsford LD. Image-guided stereotactic management of non-AIDS-related cerebral infection. Neurosurg Clin N Am 1992; 3 (2) 291-302
• 10 Ciurea AV, Stoica F, Vasilescu G, Nuteanu L. Neurosurgical management of brain abscesses in children. Childs Nerv Syst 1999; 15 (6-7) 309-317
• 11 Yadav YR, Sinha M, Parihar V ; Neha. Endoscopic management of brain abscesses. Neurol India 2008; 56 (1) 13-16
• 12 Hellwig D, Bauer BL, Dauch WA. Endoscopic stereotactic treatment of brain abscesses. Acta Neurochir Suppl (Wien) 1994; 61: 102-105
• 13 Faraji-Rad M, Samini F. Clinical features and outcome of 83 adult patients with brain abscess. Arch Iran Med 2007; 10 (3) 379-282
• 14 Yamamoto M, Fukushima T, Hirakawa K, Kimura H, Tomonaga M. Treatment of bacterial brain abscess by repeated aspiration—follow up by serial computed tomography. Neurol Med Chir (Tokyo) 2000; 40 (2) 98-104 , discussion 104–105
• 15 Takishita M, Kagawa M, Yato S , et al. Current treatment of brain abscess in patients with congenital cyanotic heart disease. Neurosurgery 1997; Dec; 41 (6) 1270-8
• 16 Emery E, Redondo A, Berthelot JL, Bouali I, Ouahes O, Rey A. [Intracranial abscess and empyema: neurosurgical management]. Ann Fr Anesth Reanim 1999; 18 (5) 567-573
• 17 Mamelak AN, Mampalam TJ, Obana WG, Rosenblum ML. Improved management of multiple brain abscesses: a combined surgical and medical approach. Neurosurgery 1995; 36 (1) 76-85 , discussion 85–86
• 18 Sharma BS, Khosla VK, Kak VK , et al. Multiple pyogenic brain abscesses. Acta Neurochir (Wien) 1995; 133 (1-2) 36-43
• 19 Mut M, Hazer B, Narin F, Akalan N, Ozgen T. Aspiration or capsule excision? Analysis of treatment results for brain abscesses at single institute. Turk Neurosurg 2009; 19 (1) 36-41
• 20 Song L, Guo F, Zhang W , et al. Clinical features and outcome analysis of 90 cases with brain abscess in central China. Neurol Sci 2008; 29 (6) 425-430
• 21 Stapleton SR, Bell BA, Uttley D. Stereotactic aspiration of brain abscesses: is this the treatment of choice?. Acta Neurochir (Wien) 1993; 121 (1-2) 15-19
• 22 Rappaport ZH, Vajda J. Intracranial Abscess: Current Concepts in Management. Neurosurg Quart 2002; 12 (3) 238-250
• 23 Kondziolka D, Duma CM, Lunsford LD. Factors that enhance the likelihood of successful stereotactic treatment of brain abscesses. Acta Neurochir (Wien) 1994; 127 (1-2) 85-90
• 24 Su TM, Lan CM, Tsai YD, Lee TC, Lu CH, Chang WN. Multiloculated pyogenic brain abscess: experience in 25 patients. Neurosurgery 2003; 52 (5) 1075-1079 , discussion 1079–1080
• 25 Tattevin P, Bruneel F, Clair B , et al. Bacterial brain abscesses: a retrospective study of 94 patients admitted to an intensive care unit (1980 to 1999). Am J Med 2003; 115 (2) 143-146
• 26 Sennaroglu L, Sozeri B. Otogenic brain abscess: review of 41 cases. Otolaryngol Head Neck Surg 2000; 123 (6) 751-755
• 27 Fenton JE, Smyth DA, Viani LG, Walsh MA. Sinogenic brain abscess. Am J Rhinol 1999; 13 (4) 299-302
• 28 Bidziński J, Koszewski W. The value of different methods of treatment of brain abscess in the CT era. Acta Neurochir (Wien) 1990; 105 (3-4) 117-120
• 29 Yang SY, Zhao CS. Review of 140 patients with brain abscess. Surg Neurol 1993; 39 (4) 290-296
• 30 Tseng JH, Tseng MY. Brain abscess in 142 patients: factors influencing outcome and mortality. Surg Neurol 2006; 65 (6) 557-562 , discussion 562