Điều trị ngoại khoa áp xe não tại Bệnh viện Đa khoa Xanh Pôn – Hà Nội

Brain abscess represents a severe and potentially life-threatening intracranial infection that demands prompt and effective management. Despite advancements in neuroimaging and antimicrobial therapy, its diagnosis and treatment remain challenging, often requiring a multidisciplinary approach due to its complex etiology, diverse clinical presentations, and potential for significant neurological morbidity and mortality. Surgical intervention is frequently crucial, not only for alleviating mass effect and reducing intracranial pressure but also for obtaining specimens for microbiological identification, which guides targeted antimicrobial therapy. This study investigates the surgical treatment outcomes of brain abscesses at Saint Paul Hospital – Hanoi, focusing on the clinical, imaging, and bacteriological characteristics, as well as the efficacy of surgical techniques, particularly phẫu thuật bóc ổ áp xe (abscess excision) and chọc hút ổ áp xe (abscess aspiration), to improve patient care and understanding of this critical condition.

Neurosurgeons, neurologists, infectious disease specialists, general practitioners, and medical researchers interested in the diagnosis and surgical management of brain abscesses, particularly in contexts similar to Vietnam.

This retrospective study, conducted at the Department of Neurosurgery, Saint Paul Hospital – Hanoi, between January 2015 and January 2025, evaluated the clinical characteristics, treatment modalities, and outcomes of 27 patients undergoing surgical management for áp xe não (brain abscess). The study aimed to describe the epidemiological, clinical, radiological, and bacteriological profiles, alongside assessing the efficacy of surgical interventions. Findings revealed a predominant patient demographic over 60 years old (48.1%), with headache (77.7%), hemiparesis (51.8%), and epilepsy (29.6%) as common presenting symptoms. Radiologically, most abscesses were trên lều (supratentorial) (88.9%) and large (≥2cm diameter, 81.5%). Surgical approaches included phẫu thuật bóc ổ áp xe (abscess excision) for 77.8% of cases and chọc hút ổ áp xe (abscess aspiration) for 22.2%, with some aspirations guided by ultrasound. Microbiological analysis identified Staphylococcus aureus as the most common pathogen (25.9%), though a significant proportion (37%) had no identifiable bacteria, highlighting diagnostic challenges potentially due to prior antibiotic use. Treatment outcomes were largely favorable, with 81.4% of patients achieving good results (GOS IV-V) at discharge, improving to 85.2% at three months post-surgery. The mortality rate was low at 3.8%. The study emphasizes that surgical treatment for brain abscess, often involving phẫu thuật bóc ổ áp xe to relieve pressure and identify pathogens, yields promising results. For deep lesions, chọc hút ổ áp xe with intraoperative ultrasound guidance is a valuable technique, enhancing precision and safety. The multidisciplinary management and early intervention contribute significantly to these positive outcomes, underscoring the importance of comprehensive care in improving patient prognosis and reducing mortality associated with brain abscess.