ABSTRACT
Background: Despite the advent of newer antibiotics and surgical strategies, the overall outcome and quality of life issues in Brain Abscess (BA) patients remain a continuous challenge for the neurosurgical community.Methods: Fifty-six patients with BA are analyzed retrospectively, that treated between January 2014 and June 2019, according to age, the clinical symptoms, etiologic factors, infecting organisms, prognostic factors, localization, diagnostic and treatment methods and outcome.Results: In acute cases, common clinical features were headache, fever, vomiting, focal deficit and seizure. In chronic abscesses, common clinical features were mild to moderate headache and progressive focal deficit. In 12(21.42%) patients had adjacent localized sinus, middle ear infection. In 27(48.21%) patients no primary source of infection was identified, predisposing factors included post neurosurgery (8.92%), post penetrating injury (3.57%), and congenital heart disease, infective endocarditis, sinusitis. The frontal lobe involved in 28.5% cases, temporal lobe and cerebellum are next to be involved. Burr hole aspiration in 29(51.78%) cases, a craniotomy was done in 15(26.78%) cases. Pus culture was negative in 36 (64.28%) cases. Mortality was noted in 2(3.57%) cases. Complete resolution of the abscess with complete recovery of preoperative neuro-deficit was seen in 71.42% cases and recovery with major neuro-deficit was observed in 16.07% cases. The best outcome was seen with a better Glasgow Coma Scale (GCS) on admission.Conclusions: BA, when surgery is required, should be done on an emergency basis. BA treated with burr hole aspiration shows excellent clinical and radiological response. A craniotomy is required in selected cases and is a primary procedure in cerebellar, postoperative and posttraumatic abscesses. Broad-spectrum antibiotic therapy should be administered for a period of minimum 6 weeks to prevent relapse.
ABSTRACT
Background: There is considerable debate in the surgical management of epidermoid cyst, whether gross total or subtotal resection yields better long term outcomes. We present our institutional experience in evaluating the clinical presentation, diagnosis, and surgical strategy and extent of resection in the management of posterior cranial fossa epidermoid cyst.Methods: A retrospective review of 24 patients diagnosed with posterior cranial fossa epidermoid tumors surgically treated at the institution between January 2010 and July 2019.Results: A total of 24 patients who underwent surgery for intracranial epidermoid lesions were identified. Of these 13 were in the Cerebellopontine angle region, eight were in the fourth ventricle, and three in lateral cerebellar convexity. The mean duration from onset of symptoms to surgery was 1.6 years. Cranial nerve dysfunction was noted in 73% of patients preoperatively, most of them being the CPA epidermoids. Total removal was achieved in 16 patients, near-total resection in 6 patients, and subtotal removal in 2 patients. Three patients developed recurrence radiologically of them only one patient became symptomatic. The mean duration of follow-up was 3.8 years. The content of the tumor was pearly white material in all cases. Complications noted in the present series were not related to the completeness of excision. Mortality was noted in one patient.Conclusions: The present study highlights various precautions to be taken intraoperatively in the prevention of development of aseptic meningitis and concludes that total removal of epidermoids does not result in significantly increased morbidity and mortality and should be the goal of surgical treatment. However, near/subtotal resection of lesions that are densely adherent to neurovascular structures is justified, as there is no significant difference in the rate of recurrence. An endoscope can be used to assess the completeness of surgery.