title: Supratentorial and infratentorial brain abscesses: surgical treatment, complications and outcomes--a 10-year single-center study.
abstract: OBJECTIVE
  To analyze the variables determining morbidity, mortality and outcome in subjects with brain abscesses treated at a single center over a 10-year period.
  
  
  METHODS
  A retrospective study was conducted on a series of 59 patients with brain abscesses surgically treated with stereotactically guided aspiration or open craniotomy excision. Such variables as age, gender, clinical presentation, number of days to diagnosis, location, number of lesions, predisposing factors, mechanism of infection, etiological agent, and therapy were analyzed independently. Complications were defined as any deviation from the normal postoperative course occurring within 30 days of surgery, and classified according to a four-point gradual severity scale. Postoperative outcome was appraised through the Glasgow Outcome Scale (GOS) 6 months after surgery, 0-4 points were considered poor outcome and 5 points good outcome.
  
  
  RESULTS
  Eighty abscesses were diagnosed and surgically managed in 59 patients. The mean age was 44.69 years (range: 0.16-77); 59.3% were female. The median number of days to diagnosis was 7. Most frequent clinical presentations included fever (52.5%), headache (42.4%), and focal neurologic deficits (39%). Mechanism of infection was mainly hematogenous spread (32.2%). Stereotactically guided aspiration was the treatment of choice for 74.6% of the patients, whereas 25.4% of the cases were managed through open craniotomy excision. Outcome was favorable in 81.35% (n = 48) of the subjects. General morbidity was 27.1%, and mortality stood at 10.16%. Out of a total 38.98% (n = 23) of complications, two-thirds were due to medical causes. The analysis of variables revealed that only age (p = 0.02), immunosuppression (OR 5.83; p = 0.012) and hematogenous spread (p < 0.01) were associated with poor outcomes.
  
  
  CONCLUSIONS
  Immunosuppression, hematogenous spread and advanced age were predictors of poor prognosis. Most of the complications following brain abscess management were not directly related to surgery or surgical technique.
authors.affiliation: Department of Neurosurgery, Hospital Italiano de Buenos Aires, Argentina. fedelandriel@gmail.com
authors.forename: Federico
authors.initials: F
authors.lastname: Landriel
authors.forename: Pablo
authors.initials: P
authors.lastname: Ajler
authors.forename: Santiago
authors.initials: S
authors.lastname: Hem
authors.forename: Damian
authors.initials: D
authors.lastname: Bendersky
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Goldschmidt
authors.forename: Lucas
authors.initials: L
authors.lastname: Garategui
authors.forename: Eduardo
authors.initials: E
authors.lastname: Vecchi
authors.forename: Omar
authors.initials: O
authors.lastname: Konsol
authors.forename: Antonio
authors.initials: A
authors.lastname: Carrizo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology / Q000601:surgery*; D001922:Brain Abscess / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D013396:Suction / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult