Preoperative Volumetric Assessment Matched with High-Field Intraoperative Magnetic Resonance Imaging-Guided Stereotactic Evacuation of Brain Abscesses

• Published in: World neurosurgery 2016-07, Vol.91, p.238-244
• Main Authors: Pesce, Alessandro, D'Andrea, Giancarlo, Frati, Alessandro, Wierzbicki, Venceslao, Caruso, Riccardo, Raco, Antonino
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brain abscess; Brain Abscess - diagnostic imaging; Brain Abscess - surgery; Cerebral infections; Female; Humans; Intraoperative MRI; Magnetic Resonance Imaging - methods; Male; Middle Aged; Outcome and Process Assessment (Health Care); Short antibiotic therapy; Stereotactic evacuation; Stereotaxic Techniques
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.03.064

Stereotactic evacuation is currently accepted as a minimally invasive surgical procedure for the management of brain abscesses. Intraoperative magnetic resonance imaging (Io-MRI) is well established in neuro-oncology but its role has not been completely outlined for brain abscess surgery. The objective of this work is to analyze radiologic, clinical, and laboratory results in a cohort of patients with brain abscesses treated with an original protocol in which the minimally invasiveness of a stereotactic technique is matched with preoperative volumetric evaluation and Io-MRI. For each of the 12 patients included in this cohort, the following data were recorded: age, sex, location, presentation, grade of evacuation, duration of follow-up, mean preoperative and postoperative Glasgow Outcome Scale score, functional outcome, number of abscess loculations, number of Io-MRI, duration of antibiotic therapy, preoperative and postoperative laboratory findings, pathogen strains and possible recurrences. The operative time was in 10/12 patients under 90 minutes. A total of 8/12 patients needed no more than 30 days of antibiotics; 9/12 patients had minor or no sequelae and returned to normal activities; only 1 recurrence of brain abscess was recorded in the sample. Only 1 death was recorded in the sample. Although this work is intended to present preliminary results of an original protocol for the management of brain abscess, the role of a precise preoperative volumetric evaluation matched with Io-MRI in the treatment of this disease seems of great benefit, as in surgical neuro-oncology.