Evolution in management of otogenic brain abscess.

OBJECTIVE

To present the therapeutic results related with treating 103 patients with cerebral abscesses of otogenic origin during 3 various time frames (1953-1977, 1978-1989, and 1990-2011).

PATIENTS

A total of 103 patients with cerebral abscess of otogenic origin.

INTERVENTIONS

Diagnostics and treatment.

MAIN OUTCOME MEASURES

Analysis of mortality rates, abscess location and its basis, coexisting complications, neurological condition at admittance, bacteriological tests, and presentation of the results of abscess treatment with the use of neuronavigation.

RESULTS

Mortality rates dropped systematically from the initial value of 35% observed between 1953 and 1977, to 14% between 1978 and 1989, and finally reached 3% between 1990 and 2011. Abscesses were mainly located within the temporal lobe. They predominantly resulted from chronic inflammation of the middle ear. A wide panel of complications was associated with them. Strong concurrence between results of cultures taken from the ear and the abscess was noted.

CONCLUSION

Cerebral abscesses remain one of the most severe complications related with inflammation of the middle ear. Both the operative methods and the postoperative care evolved (introduction of surgical microscope, new generation of antibiotics), the preoperative diagnostics facilitating the diagnosis and localization of the abscess progressed; nonetheless, the principles underlying the operative treatment remained unchanged. Neuronavigation constitutes a very important and supportive element in the management of otogenic brain abscesses.