Intracranial abscesses: Retrospective analysis of 32 patients and review of literature.
BACKGROUND
Intracranial abscess collections, though uncommon, are dreaded complications of head trauma, neurosurgical operations, meningitis, and otogenic, mastoid, and paranasal air sinus infections. Combining surgical evacuation with the appropriate antibiotic therapy is the effective treatment for intracranial abscesses. However, literature on surgical treatment is replete with several procedures which, on their own, may not.


OBJECTIVE
To determine the epidemiology and outcomes (of various treatment modalities) of intracranial abscesses in our institution, a major referral center for neurosurgical conditions in the midwestern region of Nigeria.


METHODS
This is a retrospective analysis of demographic data as well as indications, treatment modalities, and outcomes of various surgical procedures for evacuation of intracranial abscesses between September 2006 and December 2011.


RESULTS
We carried out 40 procedures in 32 (23 male and 9 female) patients with various intracranial abscesses. These represented approximately 5.6% of all operative neurosurgical procedures in our unit since inception. Most abscesses [16, i.e. 50%] occurred in the second decade. In the first decade, there were 7 (22%), and after the age of 30 years, there were 4 (12.5%). The most susceptible single year of life was infancy with 4 (12.5%) cases of intracranial abscesses. None of the infants had features of congenital heart disease. The predisposing factors were mostly otolaryngologic (9) or posttraumatic (6). Most abscesses (41%) were located in the frontal region, and intraparenchymal (i.e. intracerebral or intracerebellar) (50%) lesions were commoner than extradural, subdural, or intraventricular lesions. The commonest procedure performed (50%) was burr hole evacuation. Four patients (12.5% of cases) died. Prognosis appears to worsen with meningitis as the predisposing infection, ventriculitis, multiple abscesses especially in infants, and immunosuppression.


CONCLUSIONS
The relative rarity of intracranial abscesses and the frequent delays in making the diagnosis render the condition a significant challenge to the clinician. A high index of suspicion, close interaction between the neurosurgeon and infectious disease specialist, with early treatment by adequate abscess drainage and appropriate antimicrobial treatment are important in their management.
Division of Neurological Surgery, Department of Surgery and Pathology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
David O
DO
Udoh
Division of Neurological Surgery, Department of Surgery and Pathology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
Emmanuel
E
Ibadin
Division of Neurological Surgery, Department of Surgery and Pathology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
Mojisola O
MO
Udoh
Abscesses; antibiotic therapy; intracranial; outcome; surgical evacuation
N Engl J Med. 1953 Jan 1;248(1):14-9
13002675
Curr Opin Neurol. 1994 Jun;7(3):223-8
7915942
Surg Neurol. 2006 Jun;65(6):557-62; discussion 562
16720170
Minim Invasive Neurosurg. 2001 Sep;44(3):135-40
11696881
Surg Neurol. 2005 Mar;63(3):254-60; discussion 260
15734518
J Microbiol Immunol Infect. 2009 Oct;42(5):405-12
20182670
Radiologe. 2004 Jul;44(7):723-32; quiz 733-4
15241598
J Med Microbiol. 2009 Sep;58(Pt 9):1247-51
19528145
Neuroradiology. 1990;32(1):19-25
2333129
Arch Otolaryngol Head Neck Surg. 2005 Nov;131(11):1017-9
16301376
J Neurosurg. 1983 Dec;59(6):972-89
6631519
Radiol Clin North Am. 1988 Jul;26(4):839-59
3289077
AJNR Am J Neuroradiol. 1997 Aug;18(7):1303-6
9282859
Pediatr Radiol. 1989;19(6-7):436
2771484
Neuroradiology. 1982;23 (4):223-5
7121816
Acta Otolaryngol. 2005 Aug;125(8):819-22
16158527
Int J Surg. 2011;9(2):136-44
21087684
Clin Neurosurg. 1966;14:25-44
5992192
Otolaryngol Head Neck Surg. 2006 May;134(5):733-6
16647525
Diagn Microbiol Infect Dis. 2000 Jul;37(3):169-79
10904190
Br Med J. 1969 Apr 5;2(5648):7-11
5304985
Eur J Clin Microbiol Infect Dis. 2007 Jan;26(1):1-11
17180609
Surg Neurol. 1999 Oct;52(4):404-10; discussion 411
10555849
J Neurosurg. 1981 Oct;55(4):590-603
6168748
Trop Geogr Med. 1994;46(3):154-6
7941005
Infect Dis Clin North Am. 2002 Sep;16(3):589-605
12371117
Transpl Infect Dis. 2000 Sep;2(3):101-11
11429020
Arch Neurol. 2009 Jun;66(6):793-5
19506144
J Neuroradiol. 2004 Jan;31(1):69-71
15026735
Crit Rev Comput Tomogr. 2004;45(3):181-224
15328703
J Child Neurol. 1995 Jul;10(4):283-8
7594262
Hum Pathol. 1981 Jan;12(1):23-8
7203451
Ann Hematol. 2004;83 Suppl 1:S42-4
15124667
Scand J Infect Dis. 2003;35(5):318-21
12875518
Clin Infect Dis. 1997 Oct;25(4):763-79; quiz 780-1
9356788
Pediatrics. 2004 Jun;113(6):1765-70
15173504
Neurol Clin. 1986 Feb;4(1):159-70
3523200
Neurosurg Rev. 2003 Jul;26(3):206-9
12845550
Ann Acad Med Singapore. 1993 May;22(3 Suppl):459-63
8215201
J Neurol Neurosurg Psychiatry. 1976 May;39(5):481-90
932767