Effectiveness of Surgical Excision in Preventing Recurrence of Multilocular Brain Abscess

Background Despite advances in surgical treatment and antimicrobial therapy reducing mortality and recurrence rates of brain abscesses, many patients still face a challenging clinical course. To assess whether selecting an appropriate surgical approach influences patient outcomes, we retrospectively analyzed cases at our hospital, with a particular focus on abscess morphology. Methods We retrospectively analyzed 20 patients who underwent surgery for brain abscesses at our hospital between March 2005 and April 2022. Brain abscesses were classified as either simple or multilocular. Recurrence was defined as an increase in abscess size on postoperative contrast-enhanced imaging, while a poor outcome was defined as a >1-point increase in the modified Rankin Scale score at discharge. Results Of the 20 patients, 18 were included in the analysis. The mean patient age was 67 ± 15 years, and 17 were men. Among the 18 abscesses, 16 were classified as simple and two as multilocular. A total of 22 surgeries were performed, including 18 as initial treatments, three for recurrence, and one for a second recurrence. The procedures consisted of two excisions, 14 aspirations, five external ventricular drainage (EVD) procedures, and one aspiration combined with EVD. In cases treated with aspiration, the recurrence rate was significantly higher in the multilocular abscess group than in the simple abscess group (75% vs. 9.1%), with an OR of 24.0 (95% CI, 1.26-63.82; p = 0.011). Conclusions In patients with multilocular brain abscesses, our findings suggest that aspiration is associated with a higher recurrence rate, while surgical excision may be a more effective treatment approach. However, further studies are needed to confirm this benefit.