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Acta Neurochir (Wien). 2016 Jul;158(7):1259-67. doi: 10.1007/s00701-016-2809-1. Epub 2016 Apr 25.

Hyperbaric oxygen therapy in spontaneous brain abscess patients: a population-based comparative cohort study.

Author information

1
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden. jiri.bartek@karolinska.se.
2
Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden. jiri.bartek@karolinska.se.
3
Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. jiri.bartek@karolinska.se.
4
Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
5
Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
6
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
7
Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
8
Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
9
Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.

Abstract

BACKGROUND:

There is a need to improve outcome in patients with brain abscesses and hyperbaric oxygen therapy (HBOT) is a promising treatment modality. The objective of this study was to evaluate HBOT in the treatment of intracranial abscesses.

METHOD:

This population-based, comparative cohort study included 40 consecutive adult patients with spontaneous brain abscess treated surgically between January 2003 and May 2014 at our institution. Twenty patients received standard therapy with surgery and antibiotics (non-HBOT group), while the remaining 20 patients also received adjuvant HBOT (HBOT group).

RESULTS:

Resolution of brain abscesses and infection was seen in all patients. Two patients had reoperations after HBOT initiation (10 %), while nine patients (45 %) in the non-HBOT group underwent reoperations (p = 0.03). Of the 26 patients who did not receive HBOT after the first surgery, 15 (58 %) had one or several recurrences that lead to a new treatment: surgery (n = 11), surgery + HBO (n = 5) or just HBO (n = 1). In contrast, recurrences occurred in only 2 of 14 (14 %) who did receive HBOT after the first surgery (p < 0.01). A good outcome (Glasgow Outcome Score [GOS] of 5) was achieved in 16 patients (80 %) in the HBOT cohort versus 9 patients (45 %) in the non-HBOT group (p = 0.04).

CONCLUSIONS:

HBOT was associated with less treatment failures and need for reoperation and seemingly with improved long-term outcome. Further, HBOT was well tolerated and safe. Prospective studies are warranted to establish the role of HBOT in the treatment of brain abscesses.

KEYWORDS:

Brain abscess; Brain empyema; Hyperbaric oxygen therapy; Intracranial brain infection

PMID:
27113742
DOI:
10.1007/s00701-016-2809-1
[Indexed for MEDLINE]

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