A Review of Brain Abscess Surgical Treatment—78 Years: Aspiration versus Excision

ObjectiveThe literature regarding surgical treatment of brain abscess was reviewed from 1990 to (and including) 2008 to supplement a previous literature review from 1930 to 1990.MethodsThe Ovid Medline database 1950–2009 with the year range limited to 1990–2009 was used to identify all articles relating to brain abscess. The results were compared with a previously published review from 1930–1990 by the senior author.ResultsThe original finding was confirmed that the high mortality from aspiration in the pre-computer tomography era decreased dramatically after computer tomographic scanning became available. In the present review, the mean mortality for aspiration post-1990 was 6.6% for publications with more than five patients. With surgical excision by craniotomy, the mean mortality in the same period was 12.7%.ConclusionsThe present review suggests that aspiration may be the first surgical choice in patients with supratentorial parenchymal brain abscesses.