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Kameda-Smith MM, Ragulojan M, Hart S, Duda TR, MacLean MA, Chainey J, Aminnejad M, Rizzuto M, Bergeron D, Eagles M, Chalil A, Langlois AM, Gariepy C, Persad A, Hasen M, Wang A, Elkaim L, Christie S, Farrokhyar F, Reddy K. A Canadian National Survey of the Neurosurgical Management of Intracranial Abscesses. Can J Neurol Sci 2023; 50:679-686. [PMID: 36184886 DOI: 10.1017/cjn.2022.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Intracerebral abscess is a life-threatening condition for which there are no current, widely accepted neurosurgical management guidelines. The purpose of this study was to investigate Canadian practice patterns for the medical and surgical management of primary, recurrent, and multiple intracerebral abscesses. METHODS A self-administered, cross-sectional, electronic survey was distributed to active staff and resident members of the Canadian Neurosurgical Society and Canadian Neurosurgery Research Collaborative. Responses between subgroups were analyzed using the Chi-square test. RESULTS In total, 101 respondents (57.7%) completed the survey. The majority (60.0%) were staff neurosurgeons working in an academic, adult care setting (80%). We identified a consensus that abscesses >2.5 cm in diameter should be considered for surgical intervention. The majority of respondents were in favor of excising an intracerebral abscess over performing aspiration if located superficially in non-eloquent cortex (60.4%), located in the posterior fossa (65.4%), or causing mass effect leading to herniation (75.3%). The majority of respondents were in favor of reoperation for recurrent abscesses if measuring greater than 2.5 cm, associated with progressive neurological deterioration, the index operation was an aspiration and did not include resection of the abscess capsule, and if the recurrence occurred despite prior surgery combined with maximal antibiotic therapy. There was no consensus on the use of topical intraoperative antibiotics. CONCLUSION This survey demonstrated heterogeneity in the medical and surgical management of primary, recurrent, and multiple brain abscesses among Canadian neurosurgery attending staff and residents.
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Affiliation(s)
- Michelle M Kameda-Smith
- McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Neurosurgery, London, UK
| | | | - Shannon Hart
- McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Neurosurgery, London, UK
| | - Taylor R Duda
- McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Neurosurgery, London, UK
| | - Mark A MacLean
- Dalhousie University, Department of Surgery, Neurosurgery, QEII Health Sciences Center, Halifax Infirmary, Halifax, Nova Scotia, Canada
| | - Jonathan Chainey
- University of Alberta, Department of Surgery, Neurosurgery, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Minoo Aminnejad
- McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Michael Rizzuto
- University of British Columbia, Department of Surgery, Neurosurgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - David Bergeron
- Université de Montreal, Department of Surgery, Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Mathew Eagles
- University of Calgary, Department of Surgery, Neurosurgery, Foothills Medical Center, Calgary, Alberta, Canada
| | - Alan Chalil
- University of Western Ontario, Department of Surgery, Neurosurgery, University Hospital, London, Ontario, Canada
| | - Anne-Mare Langlois
- Université de Sherbrooke, Department of Surgery, Neurosurgery, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Charles Gariepy
- Université de Laval, Department of Surgery, Neurosurgery, Hôpital de l'Enfant-Jésus Quebec City, Québec, Canada
| | - Amit Persad
- University of Saskatchewan, Department of Surgery, Neurosurgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Mohammed Hasen
- University of Manitoba, Department of Surgery, Neurosurgery, Health Science Center (HSC), Winnipeg, Manitoba, Canada
| | - Alick Wang
- University of Ottawa, Department of Surgery, Neurosurgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lior Elkaim
- University of McGill, Department of Surgery, Neurosurgery, Montreal Neurological Institute (MNI) Hospital, Montreal, Quebec, Canada
| | - Sean Christie
- Dalhousie University, Department of Surgery, Neurosurgery, QEII Health Sciences Center, Halifax Infirmary, Halifax, Nova Scotia, Canada
| | - Forough Farrokhyar
- McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Kesava Reddy
- McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Neurosurgery, London, UK
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Kameda-Smith MM, Duda T, Duncan DB, Ragulojan M, Jung Y, Farrokhyar F, Main C, Reddy K. Retrospective Review of the Clinical Outcomes of Surgically Managed Patients with Intracranial Abscesses: A Single-Center Review. World Neurosurg 2022; 165:e697-e711. [PMID: 35798293 DOI: 10.1016/j.wneu.2022.06.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study analyzed patient, radiologic, and clinical factors associated with operative brain abscesses and patients' functional outcomes. METHODS A retrospective analysis was conducted of neurosurgical cases of brain abscesses from 2009 to 2019 at a Canadian center. Functional outcome was recorded as Modified Rankin Scale score and Extended Glasgow Outcome Scale score. Multivariate analysis was conducted to identify relevant prognostic factors. RESULTS We identified 139 patients managed surgically for brain abscesses. Resection alone was performed in 64% of patients, whereas 26.6% underwent aspiration alone. Most were adults (93.2%) and male (68.3%). Immunocompromise risk factors included diabetes (24.5%), cancer (23.7%), and immunosuppressive therapy (11.5%). Likely sources were postoperative (17.3%), systemic spread (16.5%), and poor dentition (12.9%). Microorganisms cultured from abscess samples were mixed growth (28%), Streptococcus anginosus (24.5%), and Staphylococcus aureus (7.9%). Disposition was home (42.4%) or repatriation to a home hospital (50.4%). By Extended Glasgow Outcome Scale, 25.2% had an unfavorable outcome including a mortality of 11.5%. Factors on multivariate analysis associated with poor outcome included diabetes (odds ratio, 2.8; 95% confidence interval [CI], 1.2-5.0) and ventricular rupture (odds ratio, 5.0; 95% CI, 1.7-13.5; hazard ratio, 12; 95% CI, 3.9-37.0). Supratentorial superficial eloquently located abscess was also associated with poor outcome (hazard ratio, 5.5; 95% CI, 1.8-16.7). Outcomes were similar with surgical excision and aspiration. CONCLUSIONS Ventricular rupture and diabetes are significant risk factors for poor outcomes in intraparenchymal brain abscesses. No clear difference in outcomes was found between surgical excision or aspiration in our retrospective cohort.
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Affiliation(s)
| | - Taylor Duda
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Donald B Duncan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malavan Ragulojan
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Yongkyung Jung
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Main
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Oliveira ERA, Amorim JFS, Paes MV, Azevedo AS, Gonçalves AJS, Costa SM, Mantuano-Barradas M, Póvoa TF, de Meis J, Basílio-de-Oliveira CA, Nogueira ACMA, Alves AMB. Peripheral effects induced in BALB/c mice infected with DENV by the intracerebral route. Virology 2015; 489:95-107. [PMID: 26748331 DOI: 10.1016/j.virol.2015.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/06/2015] [Accepted: 12/15/2015] [Indexed: 12/17/2022]
Abstract
The lack of an immunocompetent animal model for dengue mimicking the disease in humans is a limitation for advances in this field. Inoculation by intracerebral route of neuroadapted dengue strains in mice is normally lethal and provides a straightforward readout parameter for vaccine testing. However, systemic effects of infection and the immune response elicited in this model remain poorly described. In the present work, BALB/c mice infected by the intracerebral route with neuroadapted DENV2 exhibited several evidences of systemic involvement. DENV-inoculated mice presented virus infective particles in the brain followed by viremia, especially in late stages of infection. Infection induced cellular and humoral responses, with presence of activated T cells in spleen and blood, lymphocyte infiltration and tissue damages in brain and liver, and an increase in serum levels of some pro-inflammatory cytokines. Data highlighted an interplay between the central nervous system commitment and peripheral effects under this experimental condition.
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Affiliation(s)
- E R A Oliveira
- Laboratory of Biotechnology and Physiology of Viral Infections, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - J F S Amorim
- Laboratory of Biotechnology and Physiology of Viral Infections, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - M V Paes
- Laboratory of Biotechnology and Physiology of Viral Infections, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - A S Azevedo
- Laboratory of Biotechnology and Physiology of Viral Infections, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - A J S Gonçalves
- Laboratory of Biotechnology and Physiology of Viral Infections, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - S M Costa
- Laboratory of Biotechnology and Physiology of Viral Infections, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - M Mantuano-Barradas
- Laboratory of Biotechnology and Physiology of Viral Infections, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - T F Póvoa
- Laboratory of Biotechnology and Physiology of Viral Infections, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - J de Meis
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - C A Basílio-de-Oliveira
- Pathological Anatomy, Hospital Gaffrée Guinle, Federal University from the State of Rio de Janeiro (UNIRIO), RJ, Brazil
| | - A C M A Nogueira
- Laboratory of Biotechnology and Physiology of Viral Infections, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - A M B Alves
- Laboratory of Biotechnology and Physiology of Viral Infections, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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