title: Open craniotomy for brain abscess: A forgotten experience?
abstract: BACKGROUND
  Brain abscess carries a high morbidity and mortality despite medical advances. In this paper, we present a single institution's experience with the surgical treatment of brain abscess.
  
  
  METHODS
  We retrospectively analyzed 33 cases of intracranial abscess who underwent surgical treatment between January 2001 and December 2009. Patients were treated with aspiration through a single burr hole, open aspiration with ultrasound guidance, or complete abscess resection. The medical records were analyzed for demographics, clinical presentation, predisposing factors, imaging, microbiological investigations, treatment, and outcomes.
  
  
  RESULTS
  There were 26 male and 7 female patients, aged between 12 and 78 years. The most common predisposing factor was head trauma. Surgical excision of the abscess was performed in 22 patients, open aspiration in 9 patients, and burr-hole aspiration in 2 patients. Repeat surgical procedure was required in six patients. Mortality in this series was 21%. A favorable outcome (Glasgow outcome scale 4 and 5) was achieved in 54%. There was no significant correlation between outcome and age, predisposing factor, treatment modality, or culture results.
  
  
  CONCLUSIONS
  In this series, most patients were treated with an open technique, either by surgical excision or open aspiration of brain abscess. An open technique may reduce the need for additional imaging, surgical treatment, and length of antibiotic therapy. In resource-limited settings, excision of brain abscess may play a more important role in patient management while maintaining favorable outcomes.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, 1709 Dryden Suite 750, Houston, TX 77030, USA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Gadgil
authors.forename: Akash J
authors.initials: AJ
authors.lastname: Patel
authors.forename: Shankar P
authors.initials: SP
authors.lastname: Gopinath
keywords: Brain abscess; craniotomy; intracranial infection