Therapy Options in the Management of Brain Abscess. Literature Review

Abstract Introduction Despite the advancements in modern neurosurgical techniques, new antibiotics, neuroimaging technologies, anesthesia practices, and microbial isolation methods, cerebral abscess remains a potentially fatal infection of the central nervous system. Its treatment remains controversial to this day. The combination of clinical and surgical interventions has been widely accepted, yielding satisfactory outcomes. Methods The literature review process primarily relied on data obtained from the Pubmed database, Bireme (Lilacs, Medline, Scielo, Medicaribe, Cochrane). Key search terms included: central nervous system infection, cerebral abscess, and treatment. After a thorough selection analysis, 103 articles covering the period from 1980 to 2023 were included in this work. Results The ideal treatment is surgical; however, clinical treatment has been employed in selected cases. Simple aspiration, stereotactic-guided aspiration, and endoscopy have been performed with efficient results. The outcomes of clinical or surgical treatment depend on factors such as the patient's age, neurological status, microbial isolation, primary cause of the abscess, number of infectious foci, location, and stage of abscess development. Corticosteroids have been recommended for cases of vasogenic cerebral edema, while anticonvulsants are indicated for supratentorial abscesses. Conclusion The combination of aspiration or excision, tailored to the specific cause, number, location, and developmental stage, and intravenous antibiotics has consistently yielded satisfactory results.