Ndubuisi Chika Anele, Ohaegbulam Samuel C, Mezue Wilfred C, Chikani Mark C, Nkwerem Sunday P, Ozor Ignatius I
Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria.
Neurosurgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
Niger J Surg. 2017 Jul-Dec;23(2):106-110. doi: 10.4103/njs.NJS_46_16.
Intracranial abscess remains a significant health-care problem. Its causes, diagnosis, treatment, and outcome are changing.
This paper reviewed the demography, examined new trends, and compared outcomes with different treatment options.
Retrospective analysis of intracranial abscesses managed at Memfys Hospital, Enugu (2004-2014) and University of Nigeria Teaching Hospital (2009-2014). Patients were followed up for at least 6 months. All patients had neuroimaging before intervention. Microscopy and culture were performed for the specimens. Intravenous antibiotics were given for 2 weeks before conversion to oral.
Seventy-nine parenchymal abscesses (eight cases per year) were managed. Peak age was the second decade of life. Previous head injury (21.5%) and meningitis (16.5%) were the most common predisposing factors. The frontal lobe was most common anatomical location (32%). Only 24% had positive culture result. Three cases were fungal infections. Seventy percent of patients managed with burr hole drainage and 37.5% of craniotomy made complete recovery. Overall, 58% of patients made complete recovery, whereas 19.0% died. Nine percent of cases died before definitive intervention. Among the 24% of patients that presented in coma, 47% died within 6 months. Most important factor influencing mortality was admission level of consciousness. Abscess recurred in 6% of cases.
Intraparenchymal abscesses in Enugu were mostly solitary lesions resulting from poorly managed head injury and meningitis. Predisposition from otitis media and systemic diseases has reduced. The proportion of fungal organisms is increasing. A significant proportion of the patients present in coma. Burr hole and aspiration of abscess is less invasive and has very good outcome.
颅内脓肿仍然是一个重大的医疗保健问题。其病因、诊断、治疗及预后正在发生变化。
本文回顾了颅内脓肿的人口统计学特征，研究了新趋势，并比较了不同治疗方案的预后情况。
对埃努古Memfys医院（2004 - 2014年）和尼日利亚大学教学医院（2009 - 2014年）收治的颅内脓肿患者进行回顾性分析。对患者进行至少6个月的随访。所有患者在干预前均接受神经影像学检查。对标本进行显微镜检查和培养。静脉使用抗生素2周后改为口服。
共处理79例实质内脓肿（每年8例）。发病高峰年龄为第二个十年。既往头部损伤（21.5%）和脑膜炎（16.5%）是最常见的易感因素。额叶是最常见的解剖部位（32%）。只有24%的患者培养结果呈阳性。3例为真菌感染。采用钻孔引流治疗的患者中有70%完全康复，开颅手术治疗的患者中有37.5%完全康复。总体而言，58%的患者完全康复，19.0%的患者死亡。9%的病例在确定性干预前死亡。在昏迷就诊的24%患者中，47%在6个月内死亡。影响死亡率的最重要因素是入院时的意识水平。6%的病例脓肿复发。
埃努古的脑实质内脓肿大多为单发病变，由处理不当的头部损伤和脑膜炎引起。中耳炎和全身性疾病导致的易感性有所降低。真菌病原体的比例在增加。相当一部分患者以昏迷就诊。钻孔引流和脓肿抽吸侵入性较小，预后良好。
