Treatment - Brain abscess

Treatment for a brain abscess usually involves a combination of medicines and surgery, depending on the size and number of brain abscesses.

A brain abscess is a medical emergency, so you'll need treatment in hospital until your condition is stable.

Treatment with medicines often begins before a diagnosis is confirmed to reduce the risk of complications.

Medicines

In some cases, it may be possible to treat an abscess with medicine alone, or surgery may be too risky.

Medicines are recommended over surgery if you have:

• several abscesses
• a small abscess (less than 2.5cm)
• an abscess deep inside the brain
• meningitis (an infection of the protective membranes that surround the brain) as well as an abscess
• hydrocephalus (a build-up of fluid on the brain)

You'll normally be given antibiotics or antifungal medicine through a drip, directly into a vein. Doctors will aim to treat the abscess and the original infection that caused it.

Surgery

If the abscess is larger than 2.5cm, it's usually necessary to drain the pus out of the abscess. However, you'll still need a course of antibiotics after surgery.

There are 2 surgical techniques for treating a brain abscess:

• simple aspiration
• craniotomy

Simple aspiration involves using a CT scan to locate the abscess and then drilling a small hole known as a "burr hole" into the skull. The pus is drained and the hole sealed.

A simple aspiration takes around an hour to complete.

Open aspiration and excisions are usually carried out using a surgical procedure known as a craniotomy.

Craniotomy

A craniotomy may be recommended if an abscess does not respond to aspiration or reoccurs at a later date.

During a craniotomy, the surgeon shaves a small section of your hair and removes a small piece of your skull bone (a bone flap) to gain access to your brain.

The abscess is then drained of pus or totally removed. CT guidance may be used during the operation, to allow the surgeon to more accurately locate the exact position of the abscess.

Once the abscess has been treated, the bone is replaced. The operation usually takes around 3 hours, which includes recovery from general anaesthetic, where you're put to sleep.

Complications of a craniotomy

As with all surgery, a craniotomy carries risks, but serious complications are uncommon.

Possible complications of a craniotomy may include: 

• swelling and bruising around your face – which is common after a craniotomy and should lessen after the operation
• headaches – these are common after a craniotomy and may last several months, but should eventually settle down
• a blood clot in the brain – further surgery may be required to remove it
• stiff jaw – the surgeon may need to make a small cut to a muscle that helps with chewing, which will heal but can become stiff for a few months; exercising the muscle by regularly chewing sugar-free gum should help relieve the stiffness
• movement of the bone flap – the bone flap in your skull may feel like it moves and you may experience a clicking sensation; this can feel strange, but it is not dangerous and will stop as the skull heals

The site of the cut (incision) in your skull can become infected, although this is uncommon. You're usually given antibiotics around the time of your operation to prevent infection.

Recovering from surgery

Once your brain abscess has been treated, you'll probably stay in hospital for several weeks so your body can be supported while you recover.

You'll also receive a number of CT scans, to make sure the brain abscess has been completely removed.

Most people need a further 6 to 12 weeks rest at home before they're fit enough to return to work or full-time education.

After treatment for a brain abscess, avoid any contact sport where there's a risk of injury to the skull, such as boxing, rugby or football.

Advice for drivers

If you've had brain surgery and you hold a driving licence, you're legally required to inform the Driver and Vehicle Licensing Agency (DVLA).

It's likely that the DVLA will suspend your driving licence due to your increased risk of having a seizure. Your licence will only be returned once your GP or surgeon confirms it's safe for you to drive.

For most people, this is likely to be 12 months after surgery without having any seizures during this time.