Endoscopic management of brain abscess

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Slide 1 :

Endoscopic treatment of brain abscess Dr Y R Yadav Head Neurosurgery unit NSCB (Govt) Medical College Jabalpur Consultant Apex Hospital & Research Center Jabalpur yadavyr@hahoo.co.in

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Endoscopic treatment of brain abscess Background: Treatment of brain abscess involves different therapeutic approaches like craniotomy, burr hole aspiration with or without insertion of a drain, stereotactic aspiration, medical management , endoscopic aspiration and stereo tactic endoscopic aspiration are described.

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Endoscopic treatment of brain abscess 4 3 7 25 No of cases Yadav YR Hellwig Fritsch Longatti

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Endoscopic treatment of brain abscess Background: Endoscopic aspiration is a minimally invasive technique which is safe and effective (Longatti et al 2006, Fritsch et al 1997, Hellwig et al 1994). Superior to stereotactic technique due to direct visualization, completeness of aspiration can be assessed & per operative bleeding can be controlled We are reporting our results of endoscopic approach of 25 patients.

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Endoscopic treatment of brain abscess Material and methods: Prospective study of 25 brain abscesses between Jan 2004 to June 2007. All brain abscesses included. Exclusion: Small abscesses of less than 1.5 cms & multilocculated abscesses. Gabb 6 degree rigid endoscope was used. Repeat CT scan within 7 & 30 days after the surgery.

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Endoscopic treatment of brain abscess Material and methods: Injection cefotaxim 1 gm, vancomycin 1 gm & metrogyl 500 gms 8 hourly used in adults pending sensitivity reports. Antibiotics according to culture & sensitivity were started later on. Intravenous antibiotics 3 weeks and oral antibiotic for another 4 weeks. Dexamethasone in all cases, tapered as rapidly as possible & given for 10-15 days.

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Endoscopic treatment of brain abscess Procedure: Burr hole site to give straight trajectory to abscess cavity. Brain cannula was inserted to confirm site of abscess, only about 5 ml pus aspirated & the sheath was introduced to puncture the abscess cavity. Vision was poor initially but improved later on. Pus aspirated using infant feeding tube / suction cannula from working channel. Contents of cavity were also removed using normal saline irrigation. Out flow channel was blocked intermittently allowing cavity to be filled up and then all the contents were aspirated gently. This procedure was repeated many times till return became clear. Abscess membrane was left in situ.

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Etiology of brain abscess 1 24

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Pre Op status of brain abscess

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Endoscopic treatment of brain abscess Results: Prospective of 25 patients of brain abscesses treated between Jan 2004 to June 2007. Age from 6 to 58 years.

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Endoscopic treatment of brain abscess: Sex distribution No of patients 17 8

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Sites of Brain abscess No of patients 14 9 1 1

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Endoscopic treatment of brain abscess Results: Operating time ranged from 30-60 minutes [average 42 minutes]. All the patients recovered completely except one who died [GCS 3]. There was no recurrence in any case.

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Incidence & type of Microorganism in Brain abscess

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Endoscopic treatment of brain abscess Results: There was no complication related to the procedure. Stay in Neurosurgery unit ranged from 5-7 days as compared to 11 in conventional open surgery. Mastoid surgery was done as a separate procedure after endoscopic surgery but in the same hospital stay. Follow-up 6 and 48 months.

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Post Op CT Findings 42% 0% No of patients

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Endoscopic treatment of brain abscess Pre operative brain abscess Post op brain abscess

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THALAMIC ABSCESS PRE OP THALAMIC ABSCESS POST OP

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Endoscopic treatment of brain abscess 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 per operative bleeding can be controlled

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Endoscopic treatment of brain abscess References: Yadav Y R, Sinha Mallika, Neha, Parihar Vijay Endoscopic management of brain abscesses Neurology India 2008,56: 13-16 Fritsch M, Manwaring KH. Endoscopic treatment of brain abscess in children. Minim Invasive Neurosurg 1997;40:103-6. Gajdhar M, Yadav YR. A case of thalamic abscess treated by endoscopic surgery. Neurol India 2005;53:345-6. Hellwig D, Bauer BL, Dauch WA. Endoscopic stereotactic treatment of brain abscesses. Acta Neurochir Suppl 1994;61:102-5. Hellwig D, Benes L, Bertalanffy H, Bauer BL. Endoscopic stereotaxy: An eight year's experience. Stereotact Funct Neurosurg 1997;68:90-7.

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THANKS

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