Shifting paradigm in brain abscess management at tertiary care centre in Nepal

作     者：Prakash Kafle Mohan Raj Sharma Sushil Krishna Shilpakar Gopal Sedain Amit Pradhanang Ram Kumar Shrestha Binod Raj Bhandari Christine Groves 

作者机构：Department of NeurosurgeryNobel Medical College Teaching HospitalBiratnagar56613Nepal Department of NeurosurgeryTribhuvan University Teaching HospitalKathmandu44613Nepal Department of Physical Medicine and RehabilitationIndiana University School of MedicineIndianapolisIN46202USA 

出 版 物：《Neuroimmunology and Neuroinflammation》 (神经免疫与神经炎症（英文版）)

年 卷 期：2018年第5卷第6期

页      面：10-17页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Abscess otogenic brain abscess tubercular abscess 

摘      要：Aim: Brain abscess is a challenging clinical entity with substantial high case fatality rates despite significant advances in imaging techniques,laboratory modalities,surgical interventions,and antimicrobial treatment.Otogenic and cardiogenic sources are among the most common.Classic clinical presentation is seen in very few cases only.Burr hole with aspiration works well with good clinical outcomes.Control of primary source in cases of ear infection in the single setting results in good outcomes,reduces for additional surgery,and decreases the duration of hospital stay.Methods: This is prospective observational study conducted at Institute of Medicine,Tribhuvan University Teaching Hospital,Kathmandu,Nepal over the period of two and a half years(from September 2014 to March 2017).We analyzed the demographic profile,management strategies and outcome of these cases diagnosed with brain abscess using Microsoft Excel 2007.Results: A total of 51 cases were undertaken for surgical management.There were 35 males and 16 females with the male to female ratio of 2.18:1.The mean age of the study population was 16.76 years with age range from 4 months to 60 years.Otogenic source was the most common.Temporal lobe was the most common abscess location.Headache was the most common clinical presentation and was seen in 86.27%of the study population.All cases were initially managed with burrhole and aspiration of the abscess.Only 3.92%(n = 2)of cases subsequently required surgical excision of the abscess wall.Only 11.76%(n = 6)of the cases required multiple aspiration.Only 19.61%(n = 10)showed positive culture.Pseudomonas aeruginosa and E.coli were the most common organisms grown.Mortality rate among the study group was 3.92%.Conclusion: With the advent of modern technology in neuroimaging,mortality due to brain abscess has significantly decreased.Joint involvement of the otorhinolaryngology team and efforts in addressing the primary source have further helped in improving outcomes in cases of otogenic brain abscess.Hence,source control is of paramount importance in managing the brain abscess.