INTRAVENTRICULAR RUPTURE OF A PURULENT BRAIN-ABSCESS - CASE-REPORT

THE MORTALITY OF patients with brain abscesses has decreased significa ntly from 38% in the 1950s to 25% in the 1980s (P = 0.003, Fisher's ex act test by decade of report; asymptotic P values based on chi(2) dist ribution with 3 degrees of freedom, 28 series, 2825 total patients). T his decrease in mortality has been attributed to improved diagnostic i maging, the evolution of neurosurgical techniques and understanding of intracranial pressure pathophysiology, greater critical care understa nding, and newer antibiotics. However, the mortality associated with t he intraventricular rupture of brain abscesses (IVROBA) remained consi stently high (at or above 80% once IVROBA was identified) throughout t hese decades. Although 129 cases (84.5% mortality, 20 survivors) of IV ROBA were located in these series and an additional six case reports o f survival after IVROBA were found in the literature, treatment advice and detailed clinical description of these surviving cases are sparse or absent. A case of IVROBA with good quality of survival is presente d along with the aggressive five-component therapeutic plan used. The five components are: 1) open craniotomy with debridement of abscess ca vity, 2) lavage of the ventricular system, 3) 6 weeks of intravenous a ntibiotics, 4) intraventricular gentamicin twice daily for 6 weeks, an d 5) intraventricular drainage for 6 weeks.