Neurosurgical Unit, Treviso Hospital, University of Padova, Treviso, Italy.
Neurosurgical Unit, Spedali Civili, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
Acta Neurochir (Wien). 2020 Nov;162(11):2867-2874. doi: 10.1007/s00701-020-04301-0. Epub 2020 May 2.
Purulent intracranial infections are threatening conditions. Different surgical approaches have been described, respecting the rationale of evacuating the fluid component of the purulent collection. Emerging evidence supports the use of the endoscope for the treatment of cerebral abscesses and subdural empyemas; especially the peculiarities of flexible endoscopes could potentially offer a more effective and conclusive management as compared with the drainage through catheters. We describe our experience in the treatment of intracranial purulent collections with flexible endoscopy, comparing it with the most recent literature.
Ten patients affected by intracranial suppuration were treated with endoscopy at our institution. The neurosurgical technique is thoroughly described. The related literature is reviewed, providing a comprehensive overview on the endoscopic treatment of intracranial suppuration so far.
All the patients had a good clinical outcome, with no peri-operative complications. The postoperative scans showed significant radiological improvement, with important reduction of the pus volume. In all cases, the microbiological cultures showed positivity.
In our experience, the use of the flexible scope proved feasible and effective in the treatment of intracranial purulent collections. Visual awareness of the internal capsule is not limited to a direct inspection of the fluid pus; it rather allows an active removal of the more solid (and perhaps more microbiologically significant) fibrinoid component, and also assists in final bleeding control and in assessing the extent of the evacuation. The steering capabilities of the fiberscope are particularly suitable for such purposes, allowing sampling the solid internal layer of the pyogenic membrane, and potentially shedding light on the actual clinical significance of this component of the abscess.
化脓性颅内感染是一种威胁生命的疾病。已有多种手术方法被描述，这些方法的原理都是清除化脓性积聚物中的液体成分。新出现的证据支持使用内镜治疗脑脓肿和硬脑膜下积脓；特别是由于软性内镜的特点，与通过导管引流相比，其可能提供更有效和更具决定性的管理。我们描述了我们使用软性内镜治疗颅内脓性积聚物的经验，并与最新的文献进行了比较。
在我们的机构中，有 10 名患有颅内化脓性感染的患者接受了内镜治疗。详细描述了神经外科技术。综述了相关文献，对迄今为止内镜治疗颅内化脓性感染进行了全面概述。
所有患者的临床结果均良好，无围手术期并发症。术后扫描显示影像学明显改善，脓液量明显减少。在所有情况下，微生物培养均呈阳性。
根据我们的经验，软性内镜的使用在治疗颅内脓性积聚物方面是可行且有效的。对内囊的视觉意识不仅限于直接检查液体脓液；它还可以主动清除更固体（可能更具有微生物学意义）的纤维蛋白成分，并有助于最终控制出血和评估清除的程度。纤维内镜的转向能力特别适合这种目的，可以对脓性膜的固体内层进行采样，并可能揭示该脓肿成分的实际临床意义。
