Shahzadi S, Lozano A M, Bernstein M, Guha A, Tasker R R
Division of Neurosurgery, Toronto Hospital, University of Toronto, Ontario, Canada.
Can J Neurol Sci. 1996 Feb;23(1):34-9. doi: 10.1017/s0317167100039159.
CT and MR guided stereotactic techniques have provided promising results in the management of brain abscesses. We reviewed our results of stereotactic management of brain abscesses in 20 consecutive patients with 28 abscesses from 1986 to 1993.
13 abscesses were in the cerebral hemispheres, 12 in the cerebellum, 2 in the pons and 1 in the thalamus. The bacterial organism was isolated in 12 of the 20 cases. All patients, except one who had a tuberculous abscess, were on antibiotics for less than 7 weeks.
Although there were 3 patients in coma before surgery, the mortality rate was zero and 17 patients had an excellent recovery with 3 patients having a persistent mild neurologic disability. Stereotactic aspiration of the largest lesion in the patients with multiple brain abscesses combined with intravenous antibiotic therapy was sufficient for the resolution of all lesions. Two of our patients treated with antibiotics alone showed abscess progression with neurologic worsening.
Stereotactic aspiration is safe, accurate, and when combined with the appropriate antibiotics, should be considered the procedure of choice in the management of brain abscesses.
CT和MR引导下的立体定向技术在脑脓肿的治疗中取得了令人满意的结果。我们回顾了1986年至1993年间连续20例患者共28个脑脓肿的立体定向治疗结果。
13个脓肿位于大脑半球，12个在小脑，2个在脑桥，1个在丘脑。20例中有12例分离出细菌病原体。除1例为结核性脓肿外，所有患者使用抗生素的时间均少于7周。
尽管术前有3例患者昏迷，但死亡率为零，17例患者恢复良好，3例患者仍有持续性轻度神经功能障碍。对多发性脑脓肿患者的最大病灶进行立体定向抽吸并联合静脉抗生素治疗足以使所有病灶消退。我们的2例仅接受抗生素治疗的患者出现脓肿进展且神经功能恶化。
立体定向抽吸安全、准确，与适当的抗生素联合使用时，应被视为脑脓肿治疗的首选方法。
