Efficacy of stereotactic aspiration in deep-seated and eloquent-region intracranial pyogenic abscesses

Xavier G. Kocherry, Thimappa Hegde, Kolluri V R Sastry, Aaron Mohanty

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Object. Intracranial abscesses located deep in the cerebral parenchyma and in eloquent regions are often difficult to manage surgically. The authors have attempted to analyze the efficacy of stereotactic aspiration in the management of these abscesses. Methods. Cases involving 22 patients (including 9 children) with deep-seated and/or eloquent-region intracranial abscesses who underwent CT- or MR imaging-guided stereotactic aspiration between January 1995 and July 2001 were analyzed. Results. A definite source of infection could be identified only in 9 of the cases. In 18 patients, the abscess was deep seated, whereas in the rest it was located in the eloquent cortex. Five patients had abscesses located in multiple sites. In 17 patients only 1 aspiration was required; in 5 others subsequent procedures were required. In the initial postaspiration CT, minor hemorrhage was noted in 3 patients not requiring further intervention. Antibiotics were administered for a period varying from 4 to 8 weeks following aspiration. An early recurrence (within 2 weeks of initial aspiration) was evident in 5 patients. All recurrent abscesses were reaspirated. In 2 patients new abscesses developed while the patients were still receiving antibiotic therapy. There were no late recurrences. In 1 patient ventriculitis developed, with subsequent hydrocephalus requiring a shunt insertion. Follow-up CT scans showed complete resolution of the abscess in all patients. There were no deaths. Conclusions. Stereotactic aspiration is a useful management option for abscesses located in eloquent or inaccessible regions. Repeated aspiration should be considered in patients in whom the initial aspiration proves ineffective or partially effective. Complete resolution may require repeated stereotactic aspirations and continued antibiotic therapy.

Original languageEnglish (US)
Article numberE13
JournalNeurosurgical Focus
Volume24
Issue number6
DOIs
StatePublished - 2008

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Abscess
Anti-Bacterial Agents
Recurrence
Hydrocephalus
Hemorrhage
Therapeutics

Keywords

  • Abscess
  • Intracranial pyogenic abscess
  • Stereotactic aspiration

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Efficacy of stereotactic aspiration in deep-seated and eloquent-region intracranial pyogenic abscesses. / Kocherry, Xavier G.; Hegde, Thimappa; Sastry, Kolluri V R; Mohanty, Aaron.

In: Neurosurgical Focus, Vol. 24, No. 6, E13, 2008.

Research output: Contribution to journalArticle

Kocherry, Xavier G. ; Hegde, Thimappa ; Sastry, Kolluri V R ; Mohanty, Aaron. / Efficacy of stereotactic aspiration in deep-seated and eloquent-region intracranial pyogenic abscesses. In: Neurosurgical Focus. 2008 ; Vol. 24, No. 6.
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N2 - Object. Intracranial abscesses located deep in the cerebral parenchyma and in eloquent regions are often difficult to manage surgically. The authors have attempted to analyze the efficacy of stereotactic aspiration in the management of these abscesses. Methods. Cases involving 22 patients (including 9 children) with deep-seated and/or eloquent-region intracranial abscesses who underwent CT- or MR imaging-guided stereotactic aspiration between January 1995 and July 2001 were analyzed. Results. A definite source of infection could be identified only in 9 of the cases. In 18 patients, the abscess was deep seated, whereas in the rest it was located in the eloquent cortex. Five patients had abscesses located in multiple sites. In 17 patients only 1 aspiration was required; in 5 others subsequent procedures were required. In the initial postaspiration CT, minor hemorrhage was noted in 3 patients not requiring further intervention. Antibiotics were administered for a period varying from 4 to 8 weeks following aspiration. An early recurrence (within 2 weeks of initial aspiration) was evident in 5 patients. All recurrent abscesses were reaspirated. In 2 patients new abscesses developed while the patients were still receiving antibiotic therapy. There were no late recurrences. In 1 patient ventriculitis developed, with subsequent hydrocephalus requiring a shunt insertion. Follow-up CT scans showed complete resolution of the abscess in all patients. There were no deaths. Conclusions. Stereotactic aspiration is a useful management option for abscesses located in eloquent or inaccessible regions. Repeated aspiration should be considered in patients in whom the initial aspiration proves ineffective or partially effective. Complete resolution may require repeated stereotactic aspirations and continued antibiotic therapy.

AB - Object. Intracranial abscesses located deep in the cerebral parenchyma and in eloquent regions are often difficult to manage surgically. The authors have attempted to analyze the efficacy of stereotactic aspiration in the management of these abscesses. Methods. Cases involving 22 patients (including 9 children) with deep-seated and/or eloquent-region intracranial abscesses who underwent CT- or MR imaging-guided stereotactic aspiration between January 1995 and July 2001 were analyzed. Results. A definite source of infection could be identified only in 9 of the cases. In 18 patients, the abscess was deep seated, whereas in the rest it was located in the eloquent cortex. Five patients had abscesses located in multiple sites. In 17 patients only 1 aspiration was required; in 5 others subsequent procedures were required. In the initial postaspiration CT, minor hemorrhage was noted in 3 patients not requiring further intervention. Antibiotics were administered for a period varying from 4 to 8 weeks following aspiration. An early recurrence (within 2 weeks of initial aspiration) was evident in 5 patients. All recurrent abscesses were reaspirated. In 2 patients new abscesses developed while the patients were still receiving antibiotic therapy. There were no late recurrences. In 1 patient ventriculitis developed, with subsequent hydrocephalus requiring a shunt insertion. Follow-up CT scans showed complete resolution of the abscess in all patients. There were no deaths. Conclusions. Stereotactic aspiration is a useful management option for abscesses located in eloquent or inaccessible regions. Repeated aspiration should be considered in patients in whom the initial aspiration proves ineffective or partially effective. Complete resolution may require repeated stereotactic aspirations and continued antibiotic therapy.

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