Brain abscesses: management and outcome analysis in a series of 84 patients during 12 year period

Authors analyze 84 cases of brain abscesses operated between January 2000 and December 2011, in the Fourth Neurosurgical Department by the same surgical team. We underline the general series profile: the mean age was 42.96 years (range: 11-75 years old), 72.62% were males, association with heart defects in seven cases (8.33%), positive bacteriological examination for germs in only 37 cases (44.04%), all negative for HIV infection. The median number of days to diagnosis was 9. Most frequent clinical presentations included headache (40.47%), fever (35.71%), focal neurologic deficits (29.76%), increased intracranial pressure (28.57%) and seizures (11.90%). The majority of cases (76.19%, n=64) presented a supposed medical condition favoring dissemination of a previous infection: malnutrition, tuberculosis, chronic alcoholism, chronic liver malady, neglected dental or ear infections, and only 5 cases (5.95%) had been diagnosed with secondary immunodeficiency syndromes following autoimmune systemic diseases. According to our treatment policy all cases except for two (treated by puncture and aspiration) benefited of open surgery and total removal of the lesions, without local recurrence. Outcome was favorable in 82.14% (n=69) of subjects. General morbidity was 26.19%, and mortality stood at 7.14%. Six cases remained with permanent motor deficit (7.14%) and four (4.76%) with controllable seizures. Out of a total of 33.33% (n=28) of complications, 64.28% were due to medical causes. Follow-up had been extended up to three years for at least 2/3 of patients, who resolved in time medical or surgical conditions which determined cerebral dissemination of the infection. Despite of a poor medical and biological condition, the patients with brain abscess outside of HIV infections benefit from neurosurgical adequate treatment, and if supportive medical and general therapy is continued and sustained, the healing and survival in good neurological status is the rule. Hematogenous spread and advance age were predictors of poor prognosis. Our findings are similar to the results of recent works, although in our series, there is a higher frequency of aerobe germs