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American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
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Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
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The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

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Endoscopic Aspiration of Brain Abcess: A Case Report

Ahmed Al Azri, Sharad S Rajamani, Neeraj Salhotra*, Samit Biniwale, Ahmed Tolba, Mahmood Al hatali

Department of Neurosurgery, Neurosurgeon Khoula Hospital Muscat Oman

Abstract: Treatment of brain abscess is still a subject of controversy. Simple therapeutic approaches like twist drill/burr hole aspiration with or without insertion of a drain are also quite effective. There are reports of encouraging results following endoscopic treatment. We are reporting our case treated by this endoscopic approach.

Keywords: brain abscess

Received June 01, 2020; Revised July 02, 2020; Accepted July 10, 2020

Citation: Ahmed Al Azri, Sharad S Rajamani, Neeraj Salhotra, Samit Biniwale, Ahmed Tolba, Mahmood Al hatali, Endoscopic Aspiration of Brain Abcess: A Case Report. American Journal of Medical Case Reports, 8 (10). 367-369. January 2020. doi:10.12691/ajmcr-8-10-13

1. Introduction

Brain abscesses often occur in the developed world, and they are even more common in developing countries. In spite of the advent of modern neurosurgical techniques, including stereotactic brain biopsy and aspiration, better culturing techniques to identify the infectious agent, new antibiotics, and modern noninvasive neuroimaging procedures, brain abscess still poses a public health challenge, especially in developing countries. There are enormous diagnostic and therapeutic challenges and controversies in the management of brain abscess.

2. Material and Methods

A 46 yr old male was admitted in our hospital with sudden onset of deterioration in sensorium. GCS was 12/15 initially managed conservatively but later deriorated hence was intubated ventilated. A CT brain was done which revealed intraventricular haematoma owing to basal ganglionic bleed right sided. Patient was treated with external ventricular drain placement only in view of ventricular dilatation and ganglionic bleed being small as showed in Figure 1 and Figure 2. Patient was strarted on weaning mode from ventilator once scans were satisfactory. Patient got extubated and could come to ward. However gradually patient became febrile and ESR and CRP started shooting up and patient started becoming drowsy. CT and MRI with contrast revealed haematoma cavity transformation into a abscess as per Figure 3.

3. Results

Patient was planned for drainage of abscess endoscopically. A small right frontal craniotomy was done and via small corticotomy endoscope was introduced into abscess cavity. Pus was aspirated and sent for investigations. A thorough inspection of the whole abscess cavity was done and evacuation of the pus and irrigation of the cavity with antibiotics was performed and a EVD catheter was left in situ and wound was closed after replacing the bone flap. Postoperative scan as per Figure 4 was satisfactory. Klebsella pneumoniae was isolated. Patient improved gradually and received 6 weeks antibiotics as per senstivity.

Figure 1. CT scan at presentation

Figure 2. CT scan after external ventricular drain placement

Figure 3. MRI brain showing formation of an abscess in the haematoma cavity

4. Discussion

Yadav etal in 2008 described their series of patients of brain abscesses treated endoscopically. [1] Gajadhar etal in 2005 described their patient of thalamic abscess treated endoscopically. [2] Lutz etal in 1994 described in detail the abscesses in basal ganglionic region and ways to manage it. [3] Nakajima etal in 1999 described stereotactic aspiration if brain stem absecces. [4] Rajsekhar etal in 1994 described starotactic aspiration of cardiogegenic abscess. [5] Nauta etal in 1987 further described their series of stereotactic aspiration of brain stem abscesses. [6]

Figure 4. CT scan after endoscopic evacuation of brain abscess and an EVD cathter in situ

Figure 5. Pre and post operative MRI brain after endoscopic evacuation of the abscess

5. Conclusion

Endoscopic aspiration of brain abscess appears to be a safe and effective alternative method of treatment. There is direct visualization of abscess cavity, completeness of aspiration can be assessed, and perioperative bleeding can be controlled.

References

[1]   | Yadav YR, Sinha M; Neha, Parihar V. Endoscopic management of brain abscesses. Neurol India. 2008; 56(1): 13-16.
[2]   | Gajdhar M, Yadav YR. A case of thalamic abscess treated by endoscopic surgery. Neurol India. 2005; 53(3): 345-346.
[3]   | Lutz TW, Landolt H, Wasner M, Gratzl O. Diagnosis and management of abscesses in the basal ganglia and thalamus: a survey. Acta Neurochir (Wien). 1994; 127(1-2): 91-98.
[4]   | Nakajima H, Iwai Y, Yamanaka K, Kishi H. Successful treatment of brainstem abscess with stereotactic aspiration. Surg Neurol. 1999; 52(5): 445-448.
[5]   | Rajshekhar V, Chandy MJ. Successful stereotactic management of a large cardiogenic brain stem abscess. Neurosurgery. 1994; 34(2): 368-371.
[6]   | Nauta HJ, Contreras FL, Weiner RL, Crofford MJ. Brain stem abscess managed with computed tomography-guided stereotactic aspiration. Neurosurgery. 1987; 20(3): 476-480.