A review of brain abscess surgical treatment--78 years: aspiration versus excision.

OBJECTIVE: The literature regarding surgical treatment of brain abscess was reviewed from 1990 to (and including) 2008 to supplement a previous literature review from 1930 to 1990.

METHODS: The Ovid Medline database 1950-2009 with the year range limited to 1990-2009 was used to identify all articles relating to brain abscess. The results were compared with a previously published review from 1930-1990 by the senior author.

RESULTS: The original finding was confirmed that the high mortality from aspiration in the pre-computer tomography era decreased dramatically after computer tomographic scanning became available. In the present review, the mean mortality for aspiration post-1990 was 6.6% for publications with more than five patients. With surgical excision by craniotomy, the mean mortality in the same period was 12.7%.

CONCLUSIONS: The present review suggests that aspiration may be the first surgical choice in patients with supratentorial parenchymal brain abscesses.