Intracranial abscesses and empyemas: neurosurgical management.

Brain abscesses and empyemas are severe infections with lethal outcomes in the case of inappropriate treatment. The files of 34 patients with brain ab scesses, and nine with intracranial empyemas treated over eight years (1990 -1997) were analyzed retrospectively. Cases were evaluated for treatment an d compared with data from the literature. Patients with brain abscess under went either aspiration of the lesion through a burr hole (79.5% of the case s), or craniotomy and excision (8.8% of the cases); 11.7% were treated only with antibiotics. The operative mortality was 2.9% and the outcome was sat isfactory in 85% of patients. These results are in agreement with data from the literature. Prognosis is strongly related to the initial clinical stat us. Current methods of treatment include surgical aspiration of large absce sses with a mass effect, and are usually associated with a poor clinical st atus. Excision is suggested whenever aspiration procedures have failed, or in the presence of foreign material or fungal abscess. Medical treatment is indicated for small and deeply located abscesses in patients with satisfac tory clinical states. Empyemas in our series were treated with burr hole an d pus aspiration. The mortality rate was 11%, and 62.5% of the patients mad e a good recovery. In agreement with other reported studies, the method of treating subdural empyema is much less significant than an aggressive early drainage of the infection. Although brain abscesses and empyema remain a s ignificant neurosurgical concern, aggressive treatment can result in an exc ellent outcome in the majority of patients. (C) 1999 Elsevier, Paris.