Retrospective Analysis of Surgically Treated Brain Abscess: A Single Center Experience

Öz

This study aimed to retrospectively investigate the patients who were operated due to brain abscess. 29 patients who were operated due to brain abscess in our clinic between 2007-2016 were evaluated. The patients were divided into 4 groups according to the way of reaching the brain tissue of the agent. The epidemiological characteristics, clinical findings, blood infection parameters, mortality and reoperation rates of the patients were determined. Illustrative cases for each group were presented. Nineteen of 29 patients were male (65.5%) and 10 were female (34.5%). The mean age was 39.2 years. 8 of 29 patients had a direct spread (27.5%), 6 hematogenous (20.6%), 11 head trauma (37.9%) and 4 iatrogenic (13.7%). The most common site was the temporal region (41.3%). Eight of 29 patients (27.5%) were re-operated. The overall mortality rate was 27.5%. Approximately half of the patients (51.7%) had positive culture from abscess material. The most common pathogenic strains were streptococci. The most common clinical finding was headache (79.3%). Clinical triad of classic intracranial abscess was present in only 4 (13.7%) patients. As a result, the rate of mortality was high in patients with head trauma and in abscesses that occurs after surgical intervention, and rate of reoperations was high in patients with direct spread from adjacent structures.

Anahtar Kelimeler

• Brain abscess,Posttraumatic,Epidemiology,Culture,Mortality

Cerrahi Olarak Tedavi Edilen Beyin Apselerinin Retrospektif Analizi: Tek Merkez Deneyimi

Öz

Bu çalışmada beyin apsesi nedeniyle opere edilen hastaların retrospektif incelenmesi amaçlandı. 2007-2016 yılları arasında kliniğimizce beyin apsesi nedeniyle opere edilen 29 hasta değerlendirilmeye alındı. Etkenin beyin dokusuna ulaşma yolu göz önüne alınarak hastalar 4 gruba ayrıldı. Grupların epidemiyolojik özellikleri, klinik bulguları, kan enfeksiyon parametreleri, hastaların mortalite ve reoperasyon oranları belirlendi. Tüm gruplardan birer örnek sunuldu. 29 hastanın 19’u erkek (%65.5), 10’u bayandı (%34.5). Ortalama yaş 39.2 idi. 29 hastanın 8’i direkt yayılım (%27.5), 6’sı hematojen (%20.6), 11’i kafa travması (%37.9), 4’ü iatrojenik (%13.7) yollarla apseye neden olmuştu. En sık yerleşim yeri temporal bölge ( %41.3) idi. 29 hastanın 8'i (%27.5) tekrar opere edildi. Toplam mortalite oranı %27.5 idi. Hastaların yaklaşık yarısında (%51.7) apse materyalinden alınan kültür pozitifdi. En sık saptanan patojen streptokok suşlarıydı. En sık görülen klinik bulgu başağrısı (%79.3) idi. Klasik intrakranial apse klinik triadı hastaların sadece 4’ünde (%13.7) mevcuttu. Sonuç olarak kafa travması ve cerrahi girişim sonrasında oluşan abselerde mortalite, komşu yapılardan direkt yayılım yoluyla oluşan apselerde ise reoperasyon oranı yüksek bulunmuştur.

Anahtar Kelimeler

• Beyin apsesi,Posttravmatik,Epidemiyoloji,Kültür,Mortalite

Kaynakça

1. 1.Nathoo N, Nadvi SS, Narotam PK, et al: Brain abscess: mana-gement and outcome analysis of a computed tomography eraexperience with 973 patients. World Neurosurg 2011;75:716–726.
2. 2.Brouwer MC, Coutinho JM, van de Beek D: Clinical characte-ristics and outcome of brain abscess Systematic review and me-ta-analysis. Neurology 2014;82:806–813.
3. 3.Laulajainen HA, Aarnisalo AA, Lempinen L, et al: OtogenicIntracranial Abscesses, Our Experience Over the Last Four De-cades. J Int Adv Otol. 2017;13(1):40-46.
4. 4.Yendur Ö, Etuş V. Pediatrik Beyin Abseleri. Selçuk Pediatri2013;1(3):192-17.
5. 5.Tandon S, Beasley N, Swift AC: Changing trends in intracra-nial abscesses secondary to ear and sinus disease. J LaryngolOtol 2009;123:283–8.
6. 6.Carpenter J, Stapleton S, Holliman R: Retrospective analysis of49 cases of brain abscess and review of the literature. Eur J Clin Microbiol Infect Dis 2007;26:1–11
7. 7.Slazinski T: Brain abscess. Crit Care Nurs Clin North Am.2013;25(3):381-8.
8. 8.Falcone S, Post MJ: Encephalitis, cerebritis, and brain abscess:pathophysiology and imaging findings.Neuroimaging Clin NAm. 2000;10(2);333-53.

9. 9.Hakyemez B, Ergin N, Uysal S, et al: Beyin apsesi ile nekrotiktümör ayırımında difüzyon ağırlıklı MRG. Tanısal ve Girişim-sel Radyoloji 2004;10:110-118
10. 10.Tattevin P, Bruneel F, Clair B, et al: Bacterial brain abscesses:a retrospective study of 94 patients admitted to an intensive ca-re unit (1980 to 1999). Am J Med 2003;115:143–146.
11. 11.Tonon E, Scotton PG, Gallucci M, et al: Brain abscess: clinicalaspects of 100 patients. Int J Infect Dis 2006;10:103–109.
12. 12.Manzar N, Manzar B, Kumar R, et al: The study of etiologicand demographic characteristics of intracranial brain abscess: aconsecutive case series study from Pakistan. World Neurosurg 2011;76:195–200.
13. 13.Bellamy JL, Molendijk J, Reddy SK, et al: Severe infectious complications following frontal sinus fracture: the impact ofoperative delay and perioperative antibiotic use. Plast ReconstrSurg 2013;132:154–62.
14. 14.Hansen JE, Gudeman SK, Holgate RC, et al: Penetrating intrac-ranial wood wounds: clinical limitations of computerized to-mography. J Neurosurg, 1998;68;752-6.
15. 15.Lonsdale DO, Udy AA, Roberts JA, et al: Antibacterial thera-peutic drug monitoring in cerebrospinal fluid: difficulty in achi-eving adequate drug concentrations. J Neurosurg2013;118:297–301.