Department of Neurosurgery, Wentworth Hospital and University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
World Neurosurg. 2011 May-Jun;75(5-6):716-26; discussion 612-7. doi: 10.1016/j.wneu.2010.11.043.
Brain abscess (BA) is a neurosurgical emergency and despite significant medical advances, it remains a surgical challenge. A single institution's two decade computed tomography era management experience with BA is reported.
A retrospective analysis of patients with BA, admitted to the Department of Neurosurgery, Wentworth Hospital, Durban, KwaZulu-Natal, South Africa, was performed. The medical records were analyzed for demographic, clinical, neuroimaging, neurosurgical and otolaryngology management, microbiological characteristics, and their relationship to outcome.
During a 20-year period (1983-2002), 973 patients were treated. The mean age was 24.36 ± 15.1 years (range: 0.17-72 years) and 74.2% (n = 722) were men. The mean admission Glasgow Coma Score was 12.5 ± 2.83. The majority of BAs were supratentorial (n = 872, 89.6%). The causes were otorhinogenic (38.6%), traumatic (32.8%), pulmonary (7%), cryptogenic (4.6%), postsurgical (3.2%), meningitis (2.8%), cardiac (2.7%), and "other" (8.6%). Surgical drainage was performed in 97.1%, whereas 19 patients had nonoperative management. The incidence of BA decreased during the study period. Patient outcomes were good in 81.3% (n = 791), poor in 5.3% (n = 52), and death (13.4%, n = 130) at discharge. The management morbidity, which included postoperative seizures, was 24.9%. Predictors of mortality were cerebral infarction (odds ratio [OR] 31.1), ventriculitis (OR 12.9), coma (OR 6.8), hydrocephalus (OR 5.1), dilated pupils (OR 4.8), bilateral abscesses (OR 3.8), multiple abscesses (OR 3.4), HIV co-infection (OR 3.2), papilledema (OR 2.6), neurological deterioration (OR 2.4), and fever (OR 1.7).
Optimal management of BA involves surgical drainage for medium-to-large abscesses (≥2.5 cm) with simultaneous eradication of the primary source, treatment of associated hydrocephalus, and administration of high doses of intravenous antibiotics. The incidence of BA is directly related to poor socioeconomic conditions and therefore, still poses a public health challenge in developing countries.
脑脓肿（BA）是一种神经外科急症，尽管医学取得了重大进展，但它仍然是一个手术挑战。报告了单一机构在 CT 时代 20 年的 BA 管理经验。
对德班夸祖鲁-纳塔尔省南非温特沃思医院神经外科收治的 BA 患者进行回顾性分析。分析了患者的人口统计学、临床、神经影像学、神经外科和耳鼻喉科管理、微生物学特征及其与结果的关系。
在 20 年期间（1983-2002 年），共治疗了 973 名患者。平均年龄为 24.36±15.1 岁（范围：0.17-72 岁），74.2%（n=722）为男性。入院时格拉斯哥昏迷评分平均为 12.5±2.83。大多数 BA 位于幕上（n=872，89.6%）。病因包括耳源性（38.6%）、创伤性（32.8%）、肺部（7%）、隐源性（4.6%）、术后（3.2%）、脑膜炎（2.8%）、心脏（2.7%）和“其他”（8.6%）。97.1%的患者进行了手术引流，19 名患者接受了非手术治疗。在研究期间，BA 的发病率下降。出院时患者预后良好 81.3%（n=791），预后差 5.3%（n=52），死亡 13.4%（n=130）。包括术后癫痫在内的治疗并发症发生率为 24.9%。死亡的预测因素包括脑梗死（优势比[OR]31.1）、脑室炎（OR 12.9）、昏迷（OR 6.8）、脑积水（OR 5.1）、瞳孔散大（OR 4.8）、双侧脓肿（OR 3.8）、多发性脓肿（OR 3.4）、HIV 合并感染（OR 3.2）、视乳头水肿（OR 2.6）、神经功能恶化（OR 2.4）和发热（OR 1.7）。
BA 的最佳治疗方法是对直径≥2.5cm 的中大型脓肿进行手术引流，同时清除原发性病灶，治疗相关脑积水，并给予大剂量静脉抗生素。BA 的发病率与贫困的社会经济条件直接相关，因此在发展中国家仍然是一个公共卫生挑战。
