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

Journal article
Authors J. Bartek
Asgeir Store Jakola
S. Skyrman
P. Forander
P. Alpkvist
G. Schechtmann
M. Glimaker
A. Larsson
F. Lind
T. Mathiesen
Published in Acta Neurochirurgica
Volume 158
Issue 7
Pages 1259-1267
ISSN 0001-6268
Publication year 2016
Published at Institute of Neuroscience and Physiology
Pages 1259-1267
Language en
Links dx.doi.org/10.1007/s00701-016-2809-...
Keywords Brain abscess, Hyperbaric oxygen therapy, Intracranial brain infection, Brain empyema, antimicrobial agents, medical approach, management, osteomyelitis, infections, strategies, experience, children, efficacy, surgery, arlson me, 1987, journal of chronic diseases, v40, p373
Subject categories Neurosciences

Abstract

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. 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). 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). 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.

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