Surgical aspiration versus excision for intraparenchymal abscess: a systematic review and Meta-analysis

Abstract

Brain abscesses are associated with considerable morbidity and mortality, requiring timely intervention to achieve favourable outcomes. With the advent of high-resolution computed tomography (CT) imaging, mortality following both aspiration and excision of brain abscesses has improved markedly. As a result, there has been a marked shift in neurosurgical practice with aspiration eclipsing excision as the favoured first-line modality for most abscesses. However, this trend lacks sufficient supporting evidence, and this systematic review and meta-analysis seeks to compare aspiration and excision in the treatment of brain abscess. Twenty-seven studies were included in the systematic review, and seven comparative papers in meta-analysis. Aspiration was the chosen technique for 67.5% of patients. Baseline characteristics from the studies included only in the systematic review demonstrated that abscesses treated by aspiration were typically larger and in a deeper location than those excised. In the meta-analysis, we initially found no significant difference in mortality, re-operation rate, or functional outcome between the two treatment modalities. However, sensitivity analysis revealed that excision results in lower re-operation rate. On average, the included studies were of poor quality with average Methodological Index for Non-Randomized Studies (MINORS) scores of 10.3/16 and 14.43/24 for non-comparative and comparative papers respectively. Our study demonstrates that excision may offer improved re-operation rate as compared to aspiration for those abscesses where there is no prior clinical indication for either modality. However, no differences were found with respect to mortality or functional outcome. Evidence from the literature was deemed low quality, emphasizing the need for further investigation in this field, specifically in the form of large, well-controlled, comparative trials.

Keywords:

• Intraparenchymal abscess
• brain abscess
• infectious disease
• aspiration
• excision

Acknowledgements

The authors acknowledge the work of the Collaborative Research Program in Neurosurgery and Intensive Care (CRANI) McMaster research group for their input on the design, analysis, and editing of this work. Current members include Hanan Algethami, Mohamed Alhantoobi, Majid Aljoghaiman, Bradley Bergin, Stefania Conidi, Taylor Duda, Yosef Ellenbogen, Paul Engels, Forough Farrokhyar, Ekkehard Kasper, Mohamad Kesserwan, Fred Lam, Melissa Lennon, Amanda Martyniuk, Ryan McGinn, Arjun Sharma, Sujay Sharma, Michel Sourour, Radwan Takroni, Arunchala Trivedi, Brian Van Adel, and Bill Wang. The authors also acknowledge JoAnne Petropoulos for her assistance with conducting the literature search.

Disclosure statement

No potential conflict of interest was reported by the author(s).