Cossu G, Daniel R T, Messerer M
Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland.
Acta Neurochir (Wien). 2017 Mar;159(3):583-591. doi: 10.1007/s00701-016-3069-9. Epub 2017 Jan 23.
Cerebral abscesses are a rare complication after therapeutic neuro-endovascular procedures.
The aim of this article is to report a case of cerebral abscess after the endovascular embolization of a cerebral aneurysm and to discuss and review all the cases of cerebral abscess secondary to neurovascular embolization described in the literature up to now.
A 40-year-old female patient was treated using an endovascular embolization for a ruptured aneurysm of the basilar artery tip. After 2 months she presented with a cerebellar abscess. Antibiotic therapy was started, and a surgical drainage of the collection was performed, with a favorable postoperative outcome. Twelve other cases were reported in the literature, in five cases secondary to the treatment of a cerebral aneurysm, in six cases secondary to a cerebral arterio-venous malformation (AVM) and in one case secondary to a dural arterio-venous fistula (DAVF). The pathophysiology and risk factors of cerebral abscess formation are discussed in detail.
The risk of cerebral abscesses after neuro-endovascular embolization is not negligible, and a growing number of patients affected by this complication may be expected in the near future because of the spreading of neuro-endovascular techniques. The role of prophylactic antibiotic therapy in specific subgroups of patients is still debated.
脑脓肿是治疗性神经血管内介入术后一种罕见的并发症。
本文旨在报告1例脑动脉瘤血管内栓塞术后发生脑脓肿的病例，并对目前文献中描述的所有继发于神经血管栓塞的脑脓肿病例进行讨论和回顾。
一名40岁女性患者因基底动脉尖部破裂动脉瘤接受血管内栓塞治疗。2个月后，她出现小脑脓肿。开始抗生素治疗，并对脓肿进行手术引流，术后结果良好。文献中还报道了其他12例病例，其中5例继发于脑动脉瘤治疗，6例继发于脑动静脉畸形（AVM），1例继发于硬脑膜动静脉瘘（DAVF）。详细讨论了脑脓肿形成的病理生理学和危险因素。
神经血管内栓塞术后发生脑脓肿的风险不可忽视，由于神经血管内技术的推广，预计在不久的将来受此并发症影响的患者数量会不断增加。预防性抗生素治疗在特定患者亚组中的作用仍存在争议。
