Neurosurg Focus. 2025 Nov 1;59(5):E9. doi: 10.3171/2025.8.FOCUS25380.
ABSTRACT
OBJECTIVE: Multiloculated brain abscesses represent a clinical challenge due to their complex morphology and management. This study aimed to analyze the clinical features, microbiological data, radiological findings, surgical interventions, complications, and outcomes in patients diagnosed with multiloculated abscesses.
METHODS: The authors conducted a retrospective review of 120 patients diagnosed with multiloculated brain abscesses. Demographic data, clinical presentation, microbiological profile, radiological findings, surgical details, and outcomes were recorded. Statistical analysis included univariate analysis for unfavorable outcomes, with regression analysis performed to identify independent predictive factors.
RESULTS: The mean age of the cohort was 33.8 ± 19.3 years, with a male predominance (74.2%). The most common causes of abscesses were otogenic (25%), and 84.2% were supratentorial in location. Streptococcus ssp. were the most commonly isolated organisms (19.2%), although no organism could be isolated in 56.7% of samples. Surgical management included burr hole aspiration in 22.5% of patients and craniotomy and excision in 77.5%. The mortality rate of the cohort was 10%, and an unfavorable outcome at last follow-up was observed in 21.7% of patients. Univariate analysis revealed that Glasgow Coma Scale (GCS) score (p = 0.029), hydrocephalus (OR 4.88, p = 0.01), isolated organism on culture (OR 4.00, p = 0.011), and fungal abscess (OR 5.52, p = 0.021) were significant predictors of unfavorable outcomes. Regression analysis confirmed GCS score (OR 1.74, p = 0.035) and presence of hydrocephalus (OR 12.28, p = 0.003) as independent predictive factors for unfavorable outcomes. Craniotomy and excision of the abscess was protective against recurrence (OR 0.08, p < 0.005).
CONCLUSIONS: A low GCS score at presentation and hydrocephalus requiring external ventricular drainage have a significant association with poor outcomes for patients with multiloculated abscesses. Burr hole aspiration is associated with increased recurrence rates and requires reoperation. Further studies are needed to refine the surgical strategies and improve patient outcomes.
PMID:41175404 | DOI:10.3171/2025.8.FOCUS25380
