Elmallawany Mohamed, Ashry Ahmed, Alsawy Mohamed F
Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
Surg Neurol Int. 2021 Jan 28;12:36. doi: 10.25259/SNI_800_2020. eCollection 2021.
Treatment of brain abscess is still a subject of controversy. The main treatment is surgical, although medical therapy alone can be used for selected cases. The treatment of choice is aspiration, which may be performed with the aid of an endoscope or by freehand technique, with or without stereotactic or intraoperative ultrasound guidance. Excision is valuable in some cases. We are reporting our results of endoscopic approach in 12 patients.
This study included 12 patients of brain abscesses treated between January 2015 and January 2018. All the cases except those with small abscesses (<3.0 cm in diameter) were included in the study. Rigid endoscope was used. Follow-up CT scan was done in all cases within 7 and 30 days after surgery. Follow-up periods ranged between 3 and 6 months.
There were 11 patients with a history of chronic otitis media and one patient who suffered from congenital cyanotic heart disease. Glasgow Coma Score (GCS) was 5 in one patient, 13 in two cases, and 14-15 in 9 cases. There were one cerebellar, six temporal, and five frontal abscesses. All the patients recovered completely except one who died (GCS 5). There was no procedure-related complication. Hospital stay ranged from 14 to 45 days with an average of 28 days. The endoscopy aided visualization of multiloculations and septation in eight patients which allowed the opening of the septations and complete evacuation.
Endoscopic aspiration is safe, easy, and represents an effective way of treatment of brain abscess through proper visualization. It can be used for ensuring the complete aspiration of contents, control of any bleeding point, and also for multiloculated abscess to identify and open the septations which may not be possible in stereotactic or any other guided aspirations.
脑脓肿的治疗仍是一个有争议的话题。主要治疗方法是手术，尽管某些特定病例可单独采用药物治疗。首选的治疗方法是穿刺抽吸，可借助内镜或徒手技术进行，有无立体定向或术中超声引导均可。在某些情况下，切除手术也很有价值。我们报告了12例采用内镜治疗方法的结果。
本研究纳入了2015年1月至2018年1月期间治疗的12例脑脓肿患者。除小脓肿（直径<3.0 cm）患者外，所有病例均纳入研究。使用硬质内镜。所有病例在术后7天和30天内进行了随访CT扫描。随访期为3至6个月。
11例患者有慢性中耳炎病史，1例患有先天性青紫型心脏病。格拉斯哥昏迷评分（GCS）：1例患者为5分，2例为13分，9例为14 - 15分。有1例小脑脓肿、6例颞叶脓肿和5例额叶脓肿。除1例死亡（GCS 5分）患者外，所有患者均完全康复。无手术相关并发症。住院时间为14至45天，平均28天。内镜辅助下，8例患者的多房性和分隔得以可视化，从而能够打开分隔并完全清除内容物。
内镜下穿刺抽吸安全、简便，是一种通过适当可视化治疗脑脓肿的有效方法。它可用于确保内容物的完全抽吸、控制任何出血点，也可用于多房性脓肿，以识别和打开在立体定向或任何其他引导下穿刺抽吸时可能无法做到的分隔。
