Nonoperative treatment of neurosurgical infections

Abstract

The indications for nonsurgical management of CNS infections manifested by collections of pus are very limited. In general, such management is restricted to neurologically intact patients who are unable to undergo the needed surgical procedure and in whom the organism can be identified presumptively from other cultures. In such circumstances, brain abscesses less than 1.5 cm in diameter, small subdural empyemas, some spinal epidural abscesses, and many cases of spinal osteomyelitis can be successfully treated with prolonged intravenous antibiotic therapy. In patients who are unable to tolerate a neurosurgical procedure, the presence of an infectious CNS mass lesion is not hopeless and vigorous medical therapy offers the possibility of cure.