Department of Neurosciences, Unit of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
Department of Neurosciences, Unit of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
World Neurosurg. 2024 Apr;184:1-2. doi: 10.1016/j.wneu.2023.12.127. Epub 2023 Dec 29.
Brain abscess is a focal infection occurring within the brain parenchyma consisting of a pus collection surrounded by a vascularized capsule and a fibrinous-caseous layer between the pus and capsule. Surgery is indicated for lesions with a diameter >25 mm. Different surgical approaches have been described, including puncturing of the abscess (under neuronavigation, stereotactic or echographic guidance) with aspiration of the purulent fluid through a catheter and craniotomy with microsurgical removal of the purulent material and surrounding capsule. In recent years, the endoscopic approach has become more frequently used to treat brain abscesses. The theoretical advantages are visual awareness of the completeness of pus removal and the possibility of also removing the more solid fibrinoid component, which could be the source of recurrence. Craniotomy is likewise avoided. We present the case of an 11-year-old boy affected by a parieto-occipital brain abscess and initial ventriculitis who underwent endoscopic surgery. An ultrasonic aspirator was used to wash and suck the purulent material and fragment and remove the more solid fibrinoid component. The occipital horn of the lateral ventricle was also entered, and pus was removed. At the end of the procedure, a ventricular drainage tube was left in the surgical cavity. It was removed 1 day later, because the cavity had completely collapsed. The key surgical steps are presented in Video 1. The procedure was uneventful, with very good clinical and radiological results. The endoscopic technique has been shown to be a safe and effective treatment option for intracranial abscess. In the case of large superficial lesions, the surgical risks appear similar to those of simple drainage through catheters, with a possible reduction of the 20% reported recurrence rate. The use of an ultrasonic aspirator could facilitate complete and faster pus removal, increasing the efficacy of the procedure. The patient and his parents consented to the procedure and the report of the patient's case details and imaging studies. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
脑脓肿是一种发生在脑实质内的局灶性感染，由脓液积聚物组成，周围有一个血管化的囊和一层纤维蛋白状的层，位于脓液和囊之间。手术适用于直径>25mm 的病变。已经描述了不同的手术方法，包括通过导管抽吸脓肿（在神经导航、立体定向或超声引导下），以及通过开颅术切除脓性物质和周围囊。近年来，内镜方法越来越多地用于治疗脑脓肿。其理论优势在于可以直观地了解脓液清除的完整性，并有可能清除更坚实的纤维蛋白成分，这可能是复发的根源。也避免了开颅术。我们报告了一例 11 岁男孩患有顶枕叶脑脓肿和初始脑室炎，他接受了内镜手术。使用超声吸引器冲洗和抽吸脓性物质和碎片，并切除更坚实的纤维蛋白成分。还进入了侧脑室枕角，取出了脓液。手术结束时，在手术腔中留置了脑室引流管。1 天后，由于腔完全塌陷，引流管被移除。关键的手术步骤在视频 1 中呈现。手术过程顺利，临床和影像学结果非常好。内镜技术已被证明是一种安全有效的颅内脓肿治疗方法。对于大的浅表病变，手术风险似乎与单纯通过导管引流相似，可能会降低 20%的报告复发率。使用超声吸引器可以更彻底、更快地清除脓液，从而提高手术的效果。患者及其父母同意进行该手术，并同意报告患者的病例细节和影像学研究。所有涉及人类参与者的研究均符合机构和/或国家研究委员会的伦理标准以及 1964 年赫尔辛基宣言及其后修正案或类似的伦理标准。
