Treatment for a brain abscess, also called a cerebral abscess, depends on several factors, including how big it is, how many there are, what caused it, and the patient’s general state of health.
If the abscess is small – less than 2.5 centimeters (0.98 inches) across – intravenous administration of an antibiotic, anti-fungal or antiviral are probably the only treatment required.
An abscess which is more than 2.5 centimeters (0.98 inches) across will need to be drained or cut out. Aspiration = draining out the pus. Excision = cutting the abscess out.
If there are several abscesses, excision is generally deemed too risky. The surgeon will recommend aspiration.
The original infection
The original site of infection, perhaps in the lung, abdomen, or nose, will also have to be treated – generally with medication.
Craniotomy – this is a surgical operation in which an opening is made in the skull.
- The surgeon shaves a small area of scalp hair.
- A small piece of bone is removed in order to gain access to the brain.
- Often with the a CT scanner for guidance, the abscess is either drained of pus (aspiration), or removed (excision).
- The bone is replaced.
- The skin is stitched.
Surgery is required if:
- Pressure in the brain continues or worsens
- After administering medication the abscess does not shrink
- There is gas in the abscess
- It seems likely the abscess will rupture (burst).
Corticosteroids – if there is increased intracranial pressure a short course of high-dose corticosteroids may be administered.
Anticonvulsants – these are sometimes recommended to prevent seizures (fits).
Before the era of CT (computed tomography) scans brain abscesses were commonly fatal. If the patient is treated before going into a coma the death rate is estimated to be between 5% and 20%. The earlier treatment is administered the better a patient’s outlook is. An abscess deep within the brain is harder to treat.