Abstract
BACKGROUND: Brain abscesses can lead to severe clinical outcomes, including death. Most studies on brain abscesses focus either on patient cohorts including postsurgical/posttraumatic abscesses. This study aimed to assess the clinical presentation and postoperative outcomes in a homogeneous group of patients with primary, pyogenic brain abscesses who underwent surgical treatment. METHODS: We retrospectively analyzed consecutive patients with pyogenic brain abscesses treated surgically at our center from 2008 to 2023. The primary endpoint was a modified Rankin Scale (mRS) score of ≥ 3 at discharge. Secondary endpoint was preoperative clinical status (mRS ≥ 3). We statistically correlated clinical, radiographic, and microbiological parameters with these endpoints. RESULTS: A total of 60 patients (36.7% female) with a mean age of 48.5 ± 20.8 years were included in this study. Six patients (10.0%) had an unfavorable postoperative outcome, including two deaths (3.3%). Significant risk factors for poor outcomes included preoperative disturbance of consciousness (DOC) (p = 0.012) and elevated preoperative C-reactive protein (CRP) levels (p = 0.002). Larger abscess volume (37.4 mL vs. 16.1 mL, p = 0.065) and shorter mean distance to the ventricles (3 mm vs. 11.42 mm, p = 0.086) trended toward significance. The length of intensive care unit (ICU) stay was significantly longer for patients with unfavorable outcomes (p = 0.001). Upon admission, eighteen patients (30.0%) had an mRS score of ≥ 3. Elevated leukocyte count was identified as a significant risk factor for poor preoperative status (p = 0.007). Median clinical performance, measured by mRS, improved throughout the treatment course and during follow-up from 2 to 0. CONCLUSIONS: Preoperative DOC and elevated CRP levels were identified as predictors of unfavorable outcomes. Elevated leukocyte count was a predictor for poor preoperative status.