Analysis of 93 Brain Abscess Cases to Review the Effect of Intervention to Determine the Feasibility of the Management Protocol: A Tertiary Care Perspective

CONTEXT: Brain abscess is a suppurative process within the brain parenchyma, which remains a challenge for clinicians. Surgical excision or aspiration combined with prolonged antibiotics (usually 4–8 weeks) or only conservative management remains the treatment of choice. AIMS: The purpose of this study is to analyze the epidemiology of brain abscess and to determine the potential factors leading to better outcomes. SETTINGS AND DESIGN: This was a retrospective analysis of 93 patients undergoing various treatment options for brain abscess in a tertiary care center. MATERIALS AND METHODS: Their preoperative status, etiology, and microbiological and clinical outcomes were analyzed. STATISTICAL ANALYSIS USED: Statistical analysis was done by Chi-square, one-way analysis of variance, and post hoc Newman–Keuls multiple comparison test wherever applicable using SPSS software. RESULTS: Among 93 brain abscess cases, only 21 cases had a diameter <2.5 cm. Among them, conservative treatment was done for 38% of patients (8/21), aspiration for 47.6% (10/21) of patients, and excision for only 3 (14.2%) of cases. About 37.5% (3/8) persons among these conservatively managed patients had recurrence. None of the patients of <2.5 cm abscess having surgical management had recurrence or any new neurological deficits postsurgery during the 6-month follow-up. CONCLUSIONS: There was a significantly high recurrence among the nonsurgically treated patients with lesions <2.5 cm and there was no recurrence or neurological deficit after aspiration among these patients. Probably, aspiration has better results among these patients contrary to previous recommendations of antibiotic therapy alone.