Advantages of Stereotactic Aspiration on Surgical Management of Pyrogenic Brain Abscesses

腦部立體定位抽吸法治療腦膿瘍之優點

蘇泉發(Chain-Fa Su) ； 駱子文(Tzu-Wen Loh) ； 陳逸文(Yi-Wen Chen) ； 陳新源(Shin-Yuan Chen) ； 王立信(Lih-Shinn Wang)

《慈濟醫學雜誌》 16卷3期 (2004/06) Pp. 143-150

https://doi.org/10.6440/TZUCMJ.200406.0143

摘要

目的：本文擬評估電腦斷層導引之立體定位抽吸合併術後抗生素使用，對腦膿瘍治療之效果。病人與方法：病人共13位，男性9位，女性4位，年齡分布自12歲至75歲不等，平均為43歲，分為立體抽吸組11位，開顱手術組2位，腦膿瘍之診斷由電腦斷層及磁共振攝影判定，再經抽吸或手術後病理確認。8位立體定位抽吸患者以BRW定位系統在局部麻醉下施行手術，餘3位抽吸患者及2位開顱患者則接受全身麻醉，術後一至二週，根據患者臨床情況再行腦部電腦斷層檢查，所有患者術後即給予抗生素，但細菌培養及敏感測試結果出來後，便施以相應之抗生素治療，持續6-8週。結果：13位患者中，8位細菌培養或細菌染色呈陽性，其間5位為streptococci viridans，而格蘭氏染色呈桿菌陽性者占2位，陽性球菌者占1位。於腦膿瘍形成有相關之疾病者共8位，慢性中耳炎2位、紅斑性狼瘡2位、糖尿病及肝硬化1位、鼻咽癌1位、肺結核病1位及頭部外傷後顱底骨折併腦脊髓液鼻漏1位。抽吸組中8位接受一次抽吸，而另3位則接受2次抽吸，所有抽吸患者11位，經抽吸後再持續使用抗生素，9位結果良好，1位仍維持原先半身輕癱，另一位則因嚴重腦水腫及敗血症死亡。在手術組中2位患者均回復良好。結論：腦膿瘍使用電腦斷層導引之立體定位抽吸手術係一種微侵犯性手術，除可以確定診斷，抽出之膿 組織，更可行病理確認或細菌培養，使醫師能施以相應之抗生素治療，此手術對於深部腦區或功能區病灶之功能保護更為有用，同時抽吸本身更可降低腦壓，為腦膿瘍治療之標準手術，但對於部分嚴重腦水腫案例，急性減壓之開顱手術合併降低腦壓也有其急救之功能。

關鍵字

感染 ； 立體定位手術 ； 腦發炎

並列摘要

Objective: To evaluate the effectiveness of computed tomography (CT)-guided stereotactic aspiration of brain abscesses. Patients and Methods: Patients (9 male, 4 female; age range, 12-75 years; mean, 43 years) with an imaging-confirmed brain abscess underwent Brown-Roberts-Wells stereotactic aspiration craniotomy/craniectomy of the abscess under local or general anesthesia. Postoperatively, all patients underwent CT and received antibiotic therapy for 6-8 weeks. Antibiotics were selected on the basis of culture and sensitivity results whenever possible. Results: Bacterial cultures or Gram stains revealed Streptococcus viridans in 5, unidentified gram-positive bacilli in 2, and gram-positive cocci in 1. Underlying disease was noted in 8 patients: Two had chronic otitis media, 2 had systemic lupus erythematosus, and 1 each had diabetes mellitus with liver cirrhosis, nasopharyngeal carcinoma, pulmonary tuberculosis, and basal skull fracture. Eight patients underwent 1 aspiration procedure, and 3 patients underwent 2. After aspiration and appropriate antibiotic treatment, 9 patients had good outcomes, 1 had the same neurologic deficit as before, and 1 died from severe brain swelling and sepsis. The 2 patients undergoing craniotomy recovered. Conclusions: CT-guided stereotactic aspiration of a brain abscess is minimally invasive and allows confirmation of the culture-based diagnosis, enabling physicians to choose the proper antibiotic therapy. This procedure is particularly advantageous in managing deep-seated abscesses, multiple abscesses, or those in the eloquent brain. Aspiration of infected pus also reduces the intracranial volume. Craniotomy with removal of abscess should probably be reserved for severe brain swelling that compromises brainstem function. Further study is needed.

並列關鍵字

Infection ； stereotactic surgery ； cerebritis