Cavuşoglu Halit, Kaya Ramazan Alper, Türkmenoglu Osman Nuri, Colak Ibrahim, Aydin Yunus
Clinic of Neurosurgery, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
Neurosurg Focus. 2008;24(6):E9. doi: 10.3171/FOC/2008/24/6/E9.
In this study the authors' goal was to present the clinical and imaging results of the combined surgical and medical treatment of intracranial abscesses.
The authors retrospectively analyzed the data in 51 patients with intracranial abscesses who underwent surgery between January 1997 and November 2007. Patients were treated with aspiration through a single bur hole, total resection with open craniotomy, or image-guided stereotactic aspiration. Computed tomography or magnetic resonance imaging was performed approximately 24 hours after surgery to evaluate the size of the abscess and almost weekly during follow-up until the abscess and/or cerebral edema was reduced. Clinical results were analyzed using modified Rankin Scale (mRS) scores.
There were 36 male and 15 female patients, and their ages ranged from 14 months to 58 years (mean 29 years). Adjacent localized cranial infection was the most common predisposing factor in 31 patients (61%). Thirty-two patients were treated by repeated aspiration via a single bur hole. Streptococcus and Staphylococcus species were isolated most frequently. No statistically significant difference between causative organisms and clinical outcome was identified (p > 0.05). Assessment of overall 1-year clinical outcomes was favorable (mRS Scores 0-2) in 76.5% of patients (39 of 51 patients). The initial neurological condition was strongly correlated with the clinical outcome (p < 0.001).
A combination of surgical aspiration or removal of all abscesses > 2.5 cm in diameter, a 6-week or longer course of intravenous antibiotics, and weekly neuroimaging should yield cure rates of > 90% in patients with intracranial abscesses.
在本研究中，作者的目标是展示颅内脓肿手术和药物联合治疗的临床及影像学结果。
作者回顾性分析了1997年1月至2007年11月期间接受手术的51例颅内脓肿患者的数据。患者接受单孔钻孔抽吸、开颅全切除或影像引导立体定向抽吸治疗。术后约24小时进行计算机断层扫描或磁共振成像以评估脓肿大小，随访期间几乎每周进行一次，直至脓肿和/或脑水肿减轻。使用改良Rankin量表（mRS）评分分析临床结果。
有36例男性和15例女性患者，年龄范围为14个月至58岁（平均29岁）。31例患者（61%）中，邻近局部颅骨感染是最常见的诱发因素。32例患者通过单孔钻孔反复抽吸治疗。最常分离出链球菌和葡萄球菌属。未发现致病微生物与临床结果之间存在统计学显著差异（p>0.05）。76.5%的患者（51例中的39例）1年总体临床结果评估良好（mRS评分0 - 2）。初始神经状况与临床结果密切相关（p<0.001）。
对于颅内脓肿患者，联合手术抽吸或切除所有直径>2.5 cm的脓肿、6周或更长疗程的静脉抗生素治疗以及每周一次的神经影像学检查，治愈率应>90%。
