A NEW nationwide study finds that neurosurgical intervention significantly reduces the risk of death and complications in adult patients with brain abscess compared to non-operative care, underscoring the importance of early surgical evaluation.
Using data from 558 Danish adults diagnosed with brain abscess between 2007 and 2023, researchers conducted an emulated trial nested within a population-based cohort to assess outcomes of non-operative versus neurosurgical treatment strategies. Adjusted analyses revealed that patients managed non-operatively had more than double the risk of both mortality and abscess rupture than those who received neurosurgical treatment. Specifically, the adjusted relative risk of death with a non-operative approach was 2.47 (95% CI: 1.50–4.04), and for rupture, it was 2.25 (95% CI: 1.26–4.01).
Notably, more than one-third (36%) of patients initially managed non-operatively required delayed neurosurgery, suggesting the limitations of conservative management. Even when comparing maintained non-operative care against neurosurgery performed at any point, the risks remained higher: adjusted hazard ratios were 1.53 for mortality, 2.00 for rupture, and 1.62 for unfavorable functional outcomes, as measured by a Glasgow Outcome Scale score of 1–4 at six months post-discharge.
The study employed inverse probability weighting and doubly robust estimation to adjust for confounders such as predisposing meningitis and abscess characteristics like size and depth. While previous observational data and surveys have reflected uncertainty about the role of surgery in treating brain abscesses, this comprehensive analysis provides a strong signal favoring neurosurgical intervention as the preferred initial strategy in most cases.
The findings support current recommendations for prompt surgical drainage of brain abscesses, particularly when faced with lesions of significant size, depth, or risk of rupture. As clinical guidelines continue to evolve, this study offers real-world evidence to reinforce a proactive surgical approach in managing this potentially life-threatening condition.
Reference:
Eriksen EM et al. Non-Operative versus Neurosurgical Treatment of Brain Abscess: An Emulated Trial Nested within a Nationwide, Population-Based Cohort. Clin Infect Dis. 2025:ciaf304. [Online ahead of print].
