Healing of a brain abscess by secondary intention

Case report

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✓✓ A cerebral abscess developed in this 33-year-old man after a compound, comminuted skull fracture of the left temporoparietal region. This lesion failed to respond to standard management, which included subtotal excision and drainage. This case presented the unusual opportunity to externalize a cerebral abscess that had failed to respond to standard surgical treatment. The cerebral abscess healed rapidly by secondary intention. This may be a safe and effective option for an abscess that is walled off by granulation tissue and situated close to the cortical surface.

Article Information

Address reprint requests to: Jeffrey V. Rosenfeld, M.D., Department of Neurosurgery, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia 3004. email: j.rosenfeld@alfred.org.au.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Photograph of the penetrating, comminuted skull fracture of the left temporoparietal region before debridement of the compound fracture. Right: Admission CT scan demonstrating a comminuted, depressed fracture of the left parietal bone with extensive edema and hemorrhage in the adjacent parietal and posterior temporal lobes.

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    Left: Axial CT scan obtained on the day the patient was readmitted, revealing focal enlargement of the posterior horn of the lateral ventricle and a loculated left parietal lobe abscess. Center and Right: Axial and coronal MR images obtained after initial abscess excision, demonstrating the virtually unchanged size of the lesion.

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    Left: Axial MR image obtained after repeated abscess excision and after the wound was left open to heal by secondary intention, demonstrating resolution of the abscess. Right: Photograph of the granulating scalp wound after removal of Penrose drains and gauze packing.

References

  • 1.

    Abraham NDoudle MCarson P: Open versus closed surgical treatment of abscesses: a controlled clinical trial. Aust N Z J Surg 67:1731761997Abraham N Doudle M Carson P: Open versus closed surgical treatment of abscesses: a controlled clinical trial. Aust N Z J Surg 67:173–176 1997

  • 2.

    Barlas OSencer AErkan Ket al: Stereotactic surgery in the management of brain abscess. Surg Neurol 52:4044111999Barlas O Sencer A Erkan K et al: Stereotactic surgery in the management of brain abscess. Surg Neurol 52:404–411 1999

  • 3.

    Canale DJ: William Macewen and the treatment of brain abscesses: revisited after one hundred years. J Neurosurg 84:1331421996Canale DJ: William Macewen and the treatment of brain abscesses: revisited after one hundred years. J Neurosurg 84:133–142 1996

  • 4.

    Carey MEChou SNFrench LA: Experience with brain abscesses. J Neurosurg 36:191972Carey ME Chou SN French LA: Experience with brain abscesses. J Neurosurg 36:1–9 1972

  • 5.

    Dandy WE: The brain in Walters W (ed): Lewis' Practice of Surgery. Hagerstown, MD: WF Prior Vol 121947 pp 346369Dandy WE: The brain in Walters W (ed): Lewis' Practice of Surgery. Hagerstown MD: WF Prior Vol 12 1947 pp 346–369

  • 6.

    Dandy WE: Treatment of chronic brain abscess of the brain by tapping. Preliminary note. JAMA 87:147714781926Dandy WE: Treatment of chronic brain abscess of the brain by tapping. Preliminary note. JAMA 87:1477–1478 1926

  • 7.

    Hlavin MLRatcheson RA: Intracranial epidural abscess in Kaye AHBlack P (eds): Operative Neurosurgery Vol 2. New York: Churchill Livingstone2000 pp 16791685Hlavin ML Ratcheson RA: Intracranial epidural abscess in Kaye AH Black P (eds): Operative Neurosurgery Vol 2. New York: Churchill Livingstone 2000 pp 1679–1685

  • 8.

    Juneau PBlack P: Intra-axial cerebral infectious processes in Apuzzo MLJ (ed): Brain Surgery: Complication Avoidance and Management. New York: Churchill Livingstone1993 pp 14111417Juneau P Black P: Intra-axial cerebral infectious processes in Apuzzo MLJ (ed): Brain Surgery: Complication Avoidance and Management. New York: Churchill Livingstone 1993 pp 1411–1417

  • 9.

    Mampalam TJRosenblum ML: Trends in the management of bacterial brain abscesses: a review of 102 cases over 17 years. Neurosurgery 23:4514581988Mampalam TJ Rosenblum ML: Trends in the management of bacterial brain abscesses: a review of 102 cases over 17 years. Neurosurgery 23:451–458 1988

  • 10.

    Morgan HWood MWMurphey F: Experience with 88 consecutive cases of brain abscess. J Neurosurg 38:6987041973Morgan H Wood MW Murphey F: Experience with 88 consecutive cases of brain abscess. J Neurosurg 38:698–704 1973

  • 11.

    Morris PJWood WC: Oxford Textbook of Surgeryed 2. London: Oxford University Press2000Morris PJ Wood WC: Oxford Textbook of Surgery ed 2. London: Oxford University Press 2000

  • 12.

    Rappaport ZHVajda J: Intracranial abscess: current concepts in management. Neurosurg Q 12:2382502002Rappaport ZH Vajda J: Intracranial abscess: current concepts in management. Neurosurg Q 12:238–250 2002

  • 13.

    Rosenfeld JVWatters DAK: Neurosurgery In The Tropics: A Practical Approach to Common Problems. London: Macmillan2000 pp 370371416–423Rosenfeld JV Watters DAK: Neurosurgery In The Tropics: A Practical Approach to Common Problems. London: Macmillan 2000 pp 370–371 416–423

  • 14.

    Semmes RE: A review of the intracranial complications of ear, nose and throat infection from the neuro-surgical standpoint. Trans Am Laryngol Rhinol Otol Soc 33:5175211927Semmes RE: A review of the intracranial complications of ear nose and throat infection from the neuro-surgical standpoint. Trans Am Laryngol Rhinol Otol Soc 33:517–521 1927

  • 15.

    Stephanov S: Surgical treatment of brain abscess. Neurosurgery 22:7247301988Stephanov S: Surgical treatment of brain abscess. Neurosurgery 22:724–730 1988

  • 16.

    Takeshita MKawamata TIzawa Met al: Prodromal signs and clinical factors influencing outcome in patients with intraventricular rupture of purulent brain abscess. Neurosurgery 48:3103172001Takeshita M Kawamata T Izawa M et al: Prodromal signs and clinical factors influencing outcome in patients with intraventricular rupture of purulent brain abscess. Neurosurgery 48:310–317 2001

  • 17.

    Taylor JC: The case for excision in the treatment of brain abscess. Br J Neurosurg 1:1731781987Taylor JC: The case for excision in the treatment of brain abscess. Br J Neurosurg 1:173–178 1987

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