title: Surgery for Pyogenic Brain Abscess over 30 Years: Evaluation of the Roles of Aspiration and Craniotomy.
abstract: OBJECTIVE
  To evaluate the roles of craniotomy and aspiration in the treatment of pyogenic brain abscess throughout 30 years of computerized tomography.
  
  
  METHODS
  A retrospective study of 224 patients who were surgically treated at Istanbul Medical Faculty, Department of Neurosurgery between 1982 and 2012 was undertaken. The records were analyzed for demographic, clinical and radiological findings, surgical interventions (resection, free-hand aspiration and image-guided aspiration), data regarding abscesses (etiological factors, site, size, number, localization and identified microorganism), corticosteroid and antibiotic usage and complications, and the outcomes were reviewed.
  
  
  RESULTS
  The male-to-female ratio was 2.2, and the mean age was 26.2±1.25 years. The most common presenting symptom was headache (56.7%), followed by nausea and vomiting (28.5%). Otitis media and mastoiditis were the most common causes of abscess (41.9%), and 44 patients had multiple abscesses. Aerobic gram-positive microorganisms were the most frequently isolated pathogens in culture (51.5%). Primary surgical interventions were as follows: craniotomy and resection (38.8%), free-hand aspiration (49.1%) and image-guided aspiration (12.1%). The aspiration-to-resection ratio was 1.36 (64/47) in the first decade, 2.94 (50/17) in the second decade and 1 (23/23) in the last decade. Age, level of consciousness at the time of admission and potent corticosteroid usage were found to be significantly associated with mortality (p=0.001, p≤0.001 and p=0,038, respectively). The total morbidity and mortality ratios were 4.9% and 9.8%, respectively. Seizures were more common in patients of craniotomy group (p=0.023).
  
  
  CONCLUSIONS
  Treatment of pyogenic brain abscess remains challenging, despite advances in surgical and imaging technology, and craniotomy retains a significant role in surgical treatment.
authors.affiliation: Istanbul University, Istanbul Medical Faculty, Department of Neurosurgery, Istanbul, Turkey.
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Aras
authors.forename: Pulat Akın
authors.initials: PA
authors.lastname: Sabanci
authors.forename: Nail
authors.initials: N
authors.lastname: Izgi
authors.forename: Osman
authors.initials: O
authors.lastname: Boyali
authors.forename: Onur
authors.initials: O
authors.lastname: Ozturk
authors.forename: Aydin
authors.initials: A
authors.lastname: Aydoseli
authors.forename: Achmet
authors.initials: A
authors.lastname: Ali
authors.forename: Altay
authors.initials: A
authors.lastname: Sencer
authors.forename: Kemal
authors.initials: K
authors.lastname: Hepgul
authors.forename: Faruk
authors.initials: F
authors.lastname: Unal
authors.forename: Orhan
authors.initials: O
authors.lastname: Barlas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents