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

Acta Neurochirurgica volume 158, pages 1259–1267 (2016)Cite this article

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.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden

    Jiri Bartek Jr, Simon Skyrman, Petter Förander, Peter Alpkvist, Gaston Schechtmann & Tiit Mathiesen

  2. Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden

    Agneta Larsson & Folke Lind

  3. Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden

    Asgeir S. Jakola

  4. Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden

    Martin Glimåker

  5. Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden

    Jiri Bartek Jr, Simon Skyrman, Petter Förander, Peter Alpkvist, Gaston Schechtmann & Tiit Mathiesen

  6. Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden

    Asgeir S. Jakola

  7. Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    Jiri Bartek Jr

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  1. Jiri Bartek Jr
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Correspondence to Jiri Bartek Jr.

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Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Funding

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.

Ethical considerations

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.

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Comment

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

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  • DOI: https://doi.org/10.1007/s00701-016-2809-1

Keywords

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