脑脓肿立体定向外科治疗

Stereotactic surgery of brain abscesses

目的进一步评价立体定向外科手术在脑脓肿治疗中的作用并探讨脑脓肿的最有效治疗方法。方法自1999年1月至2005年3月共外科手术治疗脑脓肿患者24例,其中男19,女5例,年龄7～76岁(平均44.5岁)。单发脓肿21例;多发脓肿3例。共行立体定向引导脓肿穿刺及引流手术20例:脓肿穿刺14例,穿刺置管引流6例;开颅手术切除脓肿4例。结果全部手术均获得成功,一例患者2w后复发施行了第二次定向手术,另一例于立体定向手术结束时出现癫痫大发作。出院时所有患者临床症状全部消失或明显改善,头颅CT或MRI复查显示脓肿腔消失。22例患者接受了4个月至3年的随访(平均14个月),均未见脓肿复发。结论立体定向脑脓肿穿刺抽吸和引流手术应为脑脓肿的首选治疗。

Objective To further evaluate the role of stereotactic aspiration and drainage in the treatment of brain abscesses and to discuss the most effective method for brain abscesses. Methods A total of 24 patients with brain abscess were surgically treated from January 1999 to March 2005. There were 24 males and 5 females aged from 7 to 76 years with an average of 44. 5 years. Single brain abscesses were found in 21 cases and multiple in 3 cases. A total of 20 patients were treated with stereotactic aspiration or drainage and 4 with microsurgical excision. Results All the operations were carried successfully out and only one patient needed another stereotactic aspiration two weeks later because of abscess recurrence. Seizure was found in one patient at the end of stereotactic procedure. The clinical symptoms disappeared or improved remarkably and CT or MRI reexamination demonstrated the disappearance or obviously diminution of abscesses at the time of discharge. No abscess recurrence occurred in 22 patients in the follow-up of 4 months to 3 years （ average of 14 months）. Conclusion The results suggest that stereotactic operation should be the most appropriate surgical choice for pyogenic brain abscess.