Burr-Hole aspiration for Abscess

India
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Overview

  • Burr-holes are small holes that are surgically placed in the skull, or cranium. It helps in giving most appropriate treatment to the patients requiring brain operation.
  • To get and access to the brain tissue, the skull must be opened by the surgeon. In most of the surgeries, making a hole in the skull is the best way to treat the injury or illness. Sometimes it may be done only for disruption in the skull, depending upon the nature of the complications.
  • Commonly, burr-hole procedure is used to conduct brain aspiration for abscess and treatment of subdural heamatomas. Bit is also conducted during brain tumor surgery. urr-holes are also made to help relieve pressure on the brain when some fluids, such as blood and pus, build up.

What is Brain Abscess?

Brain abscess is an emergency medical condition caused by collection of infected material, coming from local or remote infection within the brain tissue. This infection results in swelling in the brain from the collection of pus and dead cells formed as a result of the infection.

Usually these viruses, fungi or bacteria reach the brain through a wound in the head or from an infection somewhere else in the body. About 20 to 30 percent of all brain abscess cases form through the infection of other places in the body.

Brain Abscess: Causes and Risk Factors

  • Typically, bacterial infection is the cause of an abscess in the brain of a healthy person and fungal brain abscesses occurs in those who have weakened immune system. Some cases of brain abscess have been linked to a skull fracture following a head trauma or a surgical procedure.
  • Brain abscess is usually combined with congenital heart disease in children. However, it may develop at any age, but is most commonly reported in the third decade of life.

Some of the risk factors for brain abscess:

  • Weak immune system due to HIV or AIDS
  • Cancer and other chronic illness
  • Head injury or skull fracture
  • Meningitis
  • Immunosuppressant drugs, like drugs used in chemotherapy
  • Chronic sinus or middle ear infections

Brain Abscess Symptoms

Symptoms of brain abscess usually develop slowly over several weeks, but sometimes they may come suddenly. These symptoms result because of increased intracranial pressure and largely depend on the specific location of the abscess in the brain. 

Common symptoms of brain abscess are:

  • Differences in mental status, such as increased confusion and decreased responsiveness
  • Irritability
  • Speech problems
  • Decreased feeling of sensation
  • Loss of muscle function and decreased movement
  • Changes in vision
  • Changes in behavior
  • Fever and Chills
  • Vomiting
  • Stiffness and Headache

Some other brain abscess symptoms in children may include:

  • Swollen or bulging on fontanelle (soft spot on forehead)
  • Projectile vomiting
  • Spasticity in the limbs
  • High-pitched crying

Brain Abscess Prognosis and Survival Rate

Brain abscess is an emergency condition and may result in death in case of delayed or no treatment. It is estimated that 70 percent of the patient who receive time treatment survive, while 20 to 30 percent of the patients may die because of complications or absence of treatment.

Therefore, timely treatment for brain abscess can be life saving. It can be treated with the help of medication and surgery both. In some case, patients may experience long term nervous system problems after surgery.

Brain Abscess Complications

Complications of brain abscess may include:

  • Brain damage
  • Meningitis that is severe and life threatening
  • Recurrence of infection
  • Seizures

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Before the Treatment

Brain Abscess Treatment

If the abscess is deep inside your brain or it is less than 2.5 cm, it will apparently be treated with antibiotics. Generally, broad spectrum antibiotics are prescribed that kill a variety of different bacteria’s. Sometimes, more than one type of antibiotic is needed.

Surgery is often preferred if the abscess does not reduce with the use of antibiotics or in case the abscess is bigger than 2.5 cm. Removing the abscess surgically involves opening the skull and draining the abscess. After the surgery, antibiotics may also be used to treat any underlying infections.  In case surgery is recommended for the treatment of brain abscess, it will be carried out by a neurosurgeon.

There are two widely used surgical techniques to treat brain abscess:

Craniotomy:

In this procedure, a section of the skull is temporarily removed so the surgeon can access and remove the abscess from the brain.

Burr-hole:

In burr hole procedure, a small hole is drilled into the skull and a tube is inserted through the hole to help drain the brain abscess.

How it is Performed

Burr-hole Aspiration for Brain Abscess

  • Burr-hole aspiration procedure is a better way to treat the brain abscess. It is a necessary part of a major brain surgery. The skull is very hard and making a traditional incision with a scalpel is impossible.
  • However, a saw can be used to cut into skull bone, but cutting the skull takes special skills to prevent injury to the brain. Burr-hole procedure makes it possible to make controlled incision in the skull without risking penetrating trauma to the delicate brain tissues.
  • Burr-hole aspiration is usually performed with the help of CT-guided stereotaxy. A method of ultrasound guidance is also present that grant a single burr-hole access with real-time imaging of the whole procedure.
  • Typically, an ultrasound probe with a tip size of 8 x 8 mm only with frequencies of 3.5 and 5 MHz is used. After making a burr-hole, the target is identified by transdural insonation, a code of conduct is adapted and a mounted puncture-adapter guides the cannula towards the abscess under real-time imaging control.
  • Then burr hole drainage takes place as the pus is removed and the burr-hole is finally sealed. Burr hole drainage takes around one hour to complete the burr-hole aspiration to complete if only one burr-hole is made.  

Recovery

You will have to stay in hospital for a few weeks after the burr-hole aspiration, so that your body can be supported while you recover. You will also receive a number of CT scans, to confirm that the brain abscess has been fully removed.

After getting discharged, you may need a further  6 to 8 weeks rest at home before you can return to work or full-time daily activities. However, it is suggested to avoid any contact sport where there is a risk of injury to the skull, for at least 12 weeks.

Pros:

  • Short procedure
  • Minimally invasive

Cons:

It may result in certain complications such as infection, stroke, bleeding and seizures. In some cases, coma and brain damage may occur.

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