POSTOPERATIVE INTRACRANIAL ABSCESS CLINICAL ASPECTS IN THE DIFFERENTIAL-DIAGNOSIS TO EARLY RECURRENCE OF MALIGNANT GLIOMA

Out of 2941 patients who received a clean, major craniotomy, 39 patien ts (1.3%) developed the complication of an intracranial deep infection , i.e. abscess or empyema. A total of 14 patients with a postoperative abscess were initially operated upon intracerebral malignant glioma ( WHO III or IV) and could be compared to a matched group of patients wi th recurrent malignancy concerning clinical and radiological aspects. A statistically significant elevation of median values was seen for er ythrocyte sedimention rate (ESR), fibrinogen and body temperature in t he study group. C-reactive protein (CRP) was not investigated in the c ontrol group and could not be compared, but it was elevated in all abs cess patients when measured. CT-scan did not allow a safe differentiat ion between infection and recurrent glioma. Local signs like suppurati on of the wound could be observed in 71% of patients with intracranial infection. Postoperative abscesses had been diagnosed in all cases wi thin 3 months, whereas none of the early recurrences of intracerebral malignoma became symptomatic before 12 weeks after initial operation. Therefore, the course of time seems to be another important factor in this differential diagnosis. (C) 1998 Elsevier Science B.V. All rights reserved.