STEREOTAXIC MANAGEMENT OF BACTERIAL BRAIN ABSCESSES

Background: CT and MR guided stereotactic techniques have provided pro mising results in the management of brain abscesses. We reviewed our r esults of stereotactic management of brain abscesses in 20 consecutive patients with 28 abscesses from 1986 to 1993. Methods: 13 abscesses w ere in the cerebral hemispheres, 12 in the cerebellum, 2 in the pens a nd 1 in the thalamus. The bacterial organism was isolated in 12 of the 20 cases. All patients, except one who had a tuberculous abscess, wer e on antibiotics for less than 7 weeks. Results: Although there were 3 patients in coma before surgery, the mortality rate was zero and 17 p atients had an excellent recovery with 3 patients having a persistent mild neurologic disability, Stereotactic aspiration of the largest les ion in the patients with multiple brain abscesses combined with intrav enous antibiotic therapy was sufficient for the resolution of all lesi ons. Two of our patients treated with antibiotics alone showed abscess progression with neurologic worsening. Conclusion: Stereotactic aspir ation is safe, accurate, and when combined with the appropriate antibi otics, should be considered the procedure of choice in the management of brain abscesses.