Senft Christian, Seifert Volker, Hermann Elvis, Gasser Thomas
Department of Neurosurgery, Johann Wolfgang Goethe-University Clinics, Frankfurt, Germany.
Neurosurg Rev. 2009 Jan;32(1):77-84; discussion 84-5. doi: 10.1007/s10143-008-0174-0. Epub 2008 Oct 4.
Surgical intervention in cerebral abscess is indicated to confirm diagnosis, to identify pathogens for specific antibiotic therapy, or to reduce mass effect. Regarding long-term outcome, freehand or stereotactic aspiration are equally efficient compared to surgical resection. However, direct observation of relief of mass effect is not possible by either method. Six patients presenting with neurological symptoms and laboratory signs of infection and diagnosed with an intra-axial cystic lesion underwent frameless stereotactic aspiration of a cerebral abscess in our institution with the use of a mobile intraoperative magnetic resonance imaging (MRI) with a field strength of 0.15 T. Images were acquired before and during the procedure and used for neuronavigation. In all six cases, complete evacuation of the abscess with collapse of the cyst could be achieved and documented intraoperatively. No complications were observed. All patients showed clinical improvement postoperatively. We highlight the advantages of using a mobile intraoperative MRI unit with an illustrative case of a patient who had already undergone abscess evacuation without alleviation of symptoms before using intraoperative MRI. Finally, we discuss surgical treatment options of cerebral abscesses.
脑脓肿的手术干预旨在确诊、确定用于特定抗生素治疗的病原体或减轻占位效应。就长期预后而言，徒手穿刺或立体定向抽吸与手术切除同样有效。然而，两种方法都无法直接观察到占位效应的缓解情况。在我们机构，6例出现神经症状和感染实验室体征且被诊断为轴内囊性病变的患者，使用场强为0.15 T的移动式术中磁共振成像（MRI）进行了脑脓肿的无框架立体定向抽吸。在手术前和手术过程中采集图像并用于神经导航。在所有6例病例中，术中均实现并记录了脓肿的完全排空及囊肿的塌陷。未观察到并发症。所有患者术后临床症状均有改善。我们通过一个病例说明了使用移动式术中MRI设备的优势，该患者在使用术中MRI之前已经进行了脓肿引流，但症状并未缓解。最后，我们讨论了脑脓肿的手术治疗选择。
