Hyperbaric oxygen therapy in spontaneous brain abscess patients: a population-based comparative cohort study.
There is a need to improve outcome in patients with brain abscesses and hyperbaric oxygen therapy (HBOT) is a promising treatment modality. The objective of this study was to evaluate HBOT in the treatment of intracranial abscesses.



This population-based, comparative cohort study included 40 consecutive adult patients with spontaneous brain abscess treated surgically between January 2003 and May 2014 at our institution. Twenty patients received standard therapy with surgery and antibiotics (non-HBOT group), while the remaining 20 patients also received adjuvant HBOT (HBOT group).



Resolution of brain abscesses and infection was seen in all patients. Two patients had reoperations after HBOT initiation (10 %), while nine patients (45 %) in the non-HBOT group underwent reoperations (p = 0.03). Of the 26 patients who did not receive HBOT after the first surgery, 15 (58 %) had one or several recurrences that lead to a new treatment: surgery (n = 11), surgery + HBO (n = 5) or just HBO (n = 1). In contrast, recurrences occurred in only 2 of 14 (14 %) who did receive HBOT after the first surgery (p < 0.01). A good outcome (Glasgow Outcome Score [GOS] of 5) was achieved in 16 patients (80 %) in the HBOT cohort versus 9 patients (45 %) in the non-HBOT group (p = 0.04).



HBOT was associated with less treatment failures and need for reoperation and seemingly with improved long-term outcome. Further, HBOT was well tolerated and safe. Prospective studies are warranted to establish the role of HBOT in the treatment of brain abscesses.
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden. jiri.bartek@karolinska.se.|Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden. jiri.bartek@karolinska.se.|Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. jiri.bartek@karolinska.se.
Jiri
J
Bartek
Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.|Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
Asgeir S
AS
Jakola
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.|Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
Simon
S
Skyrman
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.|Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
Petter
P
Förander
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.|Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
Peter
P
Alpkvist
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.|Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
Gaston
G
Schechtmann
Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Martin
M
Glimåker
Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Agneta
A
Larsson
Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Folke
F
Lind
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.|Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
Tiit
T
Mathiesen
D000293:Adolescent; D000328:Adult; D000368:Aged; D001922:Brain Abscess / Q000628:therapy*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*
Brain abscess; Brain empyema; Hyperbaric oxygen therapy; Intracranial brain infection