Neuronavigation in the Treatment of Brain Abscesses
Brain abscess is considered as intraparenchymal accumulation of pus surrounded by capsule. Achievements in microbiological methods of diagnostics, broad-spectrum antibiotics, computer and magnetic resonance imaging have led to significant success in the diagnosis and treatment of brain abscesses over the past decades. Diagnosis and treatment of brain abscess is one of current and complex problems of modern medicine. One of them is the question of indication to the different options of surgical treatment and efficient antibiotic therapy. Currently, there is not finally resolved the issue of optimal methods of diagnosis and treatment of this pathology. Analysis of domestic and foreign literature sources, which are devoted to the problem of treatment of brain abscesses, indicates a high enough percentage of complications and functionally unsatisfactory results, justifying the need for further improvement of methods of surgical treatment of brain abscess and introduction of new methods for the diagnosis and treatment that will improve the effectiveness of therapy in such patients. The aim of the study was to improve the outcomes of surgical treatment of brain abscesses through the use of neuronavigation methods, which provide optimal access to the surgical intracranial abscess, including small size, depth or multi-location, reduce the risk of intra- and postoperative complications. Material and methods. The authors analyzed the treatment outcomes in patients with brain abscess, who underwent surgery using neuronavigation techniques. In our study, we have used a navigation system Stealth Station® Treon Plus® (Medtronic company, USA). All patients underwent clinical and instrumental examination, including an analysis of the data history, neurological examination, general clinical blood tests, reviews by otoneurologist and neuroophthalmologist. All patients underwent computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. Results and discussion. 12 patients underwent surgery using frameless neuronavigation controlled system Stealth Station® Treon Plus® (Medtronic) over the period from 2009 to 2013. The patients’ age ranged from 8 to 67 years, on an average 42.4 ± 14.9 years. There were 7 male patients, females — 3, children — 2. In our study, abscesses was solitary and single — in 10 cases (83.3 %), one patient (8.3 %) had multilocular abscess and one of them had multiple (8.3 %). Drainage of abscesses was performed in five cases, in three cases puncture and aspiration of the contents of the abscess was done, and there were four cases with total removal of the abscess capsule under the control of the navigation system. The choice of surgical tactics depended on the location, size of the abscess, severity of brain edema and dislocation syndrome, the severity of the patient’s condition. CT and MRI data were recorded in the navigation system. We have conducted preoperative planning, trajectory access was scheduled so as not to damage functionally important areas of the brain and blood vessels. The distance to the target was measured. In all cases, a clinical benefit was achieved. When assessing the intracranial state in the postoperative period, it was found that drainage of the abscess cavity were located in accordance with preoperative planning. Conclusions. The use of neuronavigation ruled out multiple attempts to puncture abscesses, allows you to select the optimal trajectory of physiologically tolerable drainage.
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