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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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
No funding was received for this research.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
The authors have conducted a retrospective population-based comparative cohort study of the value of hyperbaric oxygen therapy (HBOT) in brain abscess. They demonstrated a favorable impact of this therapy on the need for further surgical interventions and outcome.
They correctly point out the limitations of the study approach including a difference in clinical presentation severity and in the inclusion of cross-over cases to the HBOT arm. The duration of treatment with hyperbaric oxygen varied across the patient population and remains somewhat speculative.
The results are sufficiently intriguing to support a randomized prospective trial of HBOT in brain abscess including also patients with multiple abscesses and immune-compromised patients as sub-groups.
Zvi Harry Rapaport
Petah Tiqva, Israel
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Bartek, J., Jakola, A.S., Skyrman, S. et al. Hyperbaric oxygen therapy in spontaneous brain abscess patients: a population-based comparative cohort study. Acta Neurochir 158, 1259–1267 (2016). https://doi.org/10.1007/s00701-016-2809-1
- Brain abscess
- Hyperbaric oxygen therapy
- Intracranial brain infection
- Brain empyema