Synergistic Integration of Traditional Chinese Medicine and Western Medical Intervention in the Treatment of Brain Abscess: A Case Report.

Brain abscess is life-threatening and carries a high risk of mortality. Despite advances in sensitive imaging techniques, effective antimicrobial therapies, and sophisticated surgical procedures, diagnosing and treating brain abscesses remains challenging. Although empirical antimicrobial therapy and neurosurgery are considered primary treatments for brain abscesses, their efficacy is limited by potential side effects including neutropenia development, the need for repeat surgeries, and the risk of new-onset epilepsy. Here, we present a case of a 52-year-old male patient who experienced paroxysmal convulsions accompanied by left-sided limb weakness and numbness for over 2 months. Despite a brain MRI revealing a multilocular cystic lesion in the right frontal lobe, with about 28 mm × 19 mm × 21 mm in size, the patient declined neurosurgical interventions. After completing a 6-week course of antimicrobial therapy, the patient sought traditional Chinese medicine (TCM) treatment. As a result, the patient remained free of paroxysmal convulsions for about 60 days after a 4-month TCM treatment. A follow-up MRI imaging at 8 months showed a reduction in the size of the lesion in the right frontal lobe to 8 mm × 4 mm. To the best of our knowledge, this is the first well-documented case of a brain abscess that was successfully managed with a combination of antimicrobial therapy and TCM. This case report suggests that TCM may provide significant supplementary benefits in managing infections like brain abscesses. However, further evidence from prospective studies is necessary to substantiate the efficacy of Chinese herbal medicine for the treatment of brain abscesses.

Surgical Management of Tuberculosis-related Cerebral Disorders: A Retrospective Single-center Study.

BACKGROUND: Tuberculosis (TB) remains a significant global health concern, with extrapulmonary manifestations, including central nervous system involvement, posing substantial morbidity and mortality. While medical treatment with anti-TB drugs is the mainstay of therapy, certain TB-related cerebral complications, such as hydrocephalus, abscesses, and large symptomatic tuberculomas, may require surgical intervention. This study aimed to evaluate the outcomes of surgical management in patients with TB-related cerebral disorders. METHODS: A retrospective analysis was conducted on 24 patients who underwent surgical intervention for TB-related cerebral disorders, including tuberculomas, hydrocephalus, and abscesses, at a tertiary care center between 2005 and December 2020. Demographic data, clinical presentations, radiological findings, surgical techniques, and treatment outcomes were analyzed. RESULTS: The study cohort had a mean age of 35.8 ± 13.6 years, and the majority (62.5%) were male. Underlying immunodeficiency, primarily HIV infection, was present in 75% of the patients. The most common presenting symptoms were headache (83.3%), focal neurological deficits (75%), and altered mental status (54.2%). Radiological findings revealed 13 (54.2%) tuberculomas, 8 (33.3%) instances of hydrocephalus, and 3 (12.5%) abscesses. VP shunt inserted in 8 (33.3%) cases. Microscopic craniotomy performed in 7 (29.16%) cases. Aspiration through burr hole was done in 3 (12.5%) cases and stereotactic biopsy was performed in 6 (25%) cases. After 12 months of follow-up, favorable outcome achieved in 18 cases (75%) and the mortality occurred in 2 patients (8.3%). Surgical interventions included lesion resection (n = 10), stereotactic biopsy (n = 7), and ventriculoperitoneal (VP) shunt placement (n = 7). At 12-month follow-up, 18 (75%) patients had a favorable outcome, defined as clinical improvement or stabilization. Unfavorable outcomes were observed in 6 (25%) patients, including 2 deaths. CONCLUSION: Surgical management, in conjunction with appropriate anti-TB medical therapy, may be a valuable component of the comprehensive treatment approach for select patients with TB-related cerebral disorders. The favorable outcome rate observed in this study suggests that timely and tailored surgical intervention can contribute to improved patient outcomes. However, larger, prospective, multicenter studies are needed to further elucidate the role and long-term efficacy of surgical management in this patient population.

Concomitant Listeria monocytogenes and Streptococcus equinus brain abscess in an immunocompetent individual: a case report.

BACKGROUND: Listeria monocytogenes brain abscess is a rare phenomenon that is common in immunocompromised patients. Streptococcus equinus brain abscess has never been reported in the literature to our knowledge. In this case report, we describe a case of brain abscess secondary to Listeria monocytogenes and Streptococcus equinus in an immunocompetent patient with transient low CD4 count. CASE PRESENTATION: A 27-year-old white, male patient, previously healthy, nonalcoholic, and occasional smoker, presented to the emergency department for confusion and headache. The patient was found to have a left parietal abscess, which was drained and the fluid was sent for culture. Culture grew Listeria monocytogenes and Streptococcus equinus. The patient was treated with intravenous ampicillin followed by oral amoxicillin for a total of 6 weeks. The CD4 count was low initially. However, after the resolution of the infection, the CD4 count came back within normal range. Another brain magnetic resonance imaging was done that showed a significantly decreased hyperintensity within the left parietal subcortical white matter at the site of surgery with significantly decreased enhancement and almost total resolution of the previous abscess. CONCLUSION: Transient low CD4 count is a rare phenomenon that exposes patients to unusual and atypical infections. Since low CD4 count is transient, patients treated promptly recover from their illness. Our patient developed a Listeria monocytogenes and Streptococcus equinus brain abscess, which is considered rare and has not been previously described in the literature to our knowledge.

Intracranial dissemination of Klebsiella pneumoniae originating from pulmonary infection: a case report.

BACKGROUND: Metastatic brain abscesses caused by Klebsiella pneumoniae are extremely rare but life-threatening conditions. To depict a unique case of the middle-aged hypertensive man with an unusual presentation of metastatic brain abscesses originating from a pleural abscess caused by Klebsiella pneumoniae and subsequently leading to loss of consciousness (LOC). CASE REPORT: A 52-year-old Iranian man with a history of hypertension presented to the emergency department with a five-day history of worsening cough, high-grade fever, shortness of breath, chest pain, fatigue, and a productive cough. Laboratory tests revealed leukocytosis, elevated C-reactive protein, and respiratory alkalosis. A chest computed tomography scan confirmed pneumonia, and a brain scan revealed multiple hypodense lesions. Despite antibiotic therapy, the patient's condition worsened, leading to confusion, disorientation, and loss of consciousness. Magnetic resonance imaging revealed multiple ring-enhancing lesions, suggesting an abscess formation. Bronchial washings and BAL samples confirmed a lower respiratory tract infection. Cultures from the bronchial washings grew Klebsiella pneumoniae. CONCLUSIONS: Metastatic brain abscesses caused by Klebsiella pneumoniae are exceedingly rare but life-threatening conditions. Timely diagnosis and effective antimicrobial treatment are critical for patient outcomes. This case underscores the significance of recognizing atypical presentations of bacterial infections, as early detection and appropriate management can significantly impact patient outcomes.

Metagenomic next-generation sequencing could play a pivotal role in validating the diagnosis of invasive mold disease of the central nervous system.

Background: Invasive mold diseases of the central nervous (CNS IMD) system are exceedingly rare disorders, characterized by nonspecific clinical symptoms. This results in significant diagnostic challenges, often leading to delayed diagnosis and the risk of misdiagnosis for patients. Metagenomic Next-Generation Sequencing (mNGS) holds significant importance for the diagnosis of infectious diseases, especially in the rapid and accurate identification of rare and difficult-to-culture pathogens. Therefore, this study aims to explore the clinical characteristics of invasive mold disease of CNS IMD in children and assess the effectiveness of mNGS technology in diagnosing CNS IMD. Methods: Three pediatric patients diagnosed with Invasive mold disease brain abscess and treated in the Pediatric Intensive Care Unit (PICU) of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2023 were selected for this study. Results: Case 1, a 6-year-old girl, was admitted to the hospital with "acute liver failure." During her hospital stay, she developed fever, irritability, and seizures. CSF mNGS testing resulted in a negative outcome. Multiple brain abscesses were drained, and Aspergillus fumigatus was detected in pus culture and mNGS. The condition gradually improved after treatment with voriconazole combined with caspofungin. Case 2, a 3-year-old girl, was admitted with "acute B-lymphoblastic leukemia." During induction chemotherapy, she developed fever and seizures. Aspergillus fumigatus was detected in the intracranial abscess fluid by mNGS, and the condition gradually improved after treatment with voriconazole combined with caspofungin, followed by "right-sided brain abscess drainage surgery." Case 3, a 7-year-old girl, showed lethargy, fever, and right-sided limb weakness during the pending chemotherapy period for acute B-lymphoblastic leukemia. Rhizomucor miehei and Rhizomucor pusillus was detected in the cerebrospinal fluid by mNGS. The condition gradually improved after treatment with amphotericin B combined with posaconazole. After a six-month follow-up post-discharge, the three patients improved without residual neurological sequelae, and the primary diseases were in complete remission. Conclusion: The clinical manifestations of CNS IMD lack specificity. Early mNGS can assist in identifying the pathogen, providing a basis for definitive diagnosis. Combined surgical treatment when necessary can help improve prognosis.

Successful maintenance treatment of disseminated nocardiosis with cerebral abscess in a severely immunocompromised patient allergic to trimethoprim-sulfamethoxazole using moxifloxacin and high-dose minocycline: A case report.

Nocardiosis in patients after allogeneic hematopoietic stem cell transplantation (HSCT) is rare, but is associated with a significant mortality risk. Although trimethoprim-sulfamethoxazole (TMP/SMX) remains the cornerstone of nocardiosis treatment, optimal alternative therapies for patients intolerant to TMP/SMX are not well-established. Herein, we report a case of disseminated nocardiosis with bacteremia and multiple lesions in the lungs and brain caused by Nocardia farcinica, in a 60-year-old man who had previously undergone allogeneic HSCT and was receiving immunosuppressants for severe chronic graft-versus-host disease. The patient received atovaquone for the prophylaxis of Pneumocystis pneumonia because of a previous serious allergic reaction to TMP/SMX. The patient was initially treated with imipenem/cilastatin and amikacin, which were later switched to ceftriaxone and amikacin based on the results of antimicrobial susceptibility testing. After switching to oral levofloxacin and a standard dose of minocycline, the patient experienced a single recurrence of brain abscesses. However, after switching to oral moxifloxacin and high-dose minocycline, the patient did not experience any relapses during the subsequent two years and seven months of treatment. In treating nocardiosis with brain abscesses, it is crucial to select oral antibiotics based on the antimicrobial susceptibility test results and pharmacokinetics, especially when TMP/SMX is contraindicated. A combination of oral moxifloxacin and high-dose minocycline could be a promising alternative therapy.

Brain abscess caused by Actinomyces turicensis in a non-immunocompromised adult patient: a case report and systematic review of the literature.

BACKGROUND: Actinomyces turicensis is rarely responsible of clinically relevant infections in human. Infection is often misdiagnosed as malignancy, tuberculosis, or nocardiosis, therefore delaying the correct identification and treatment. Here we report a case of a 55-year-old immunocompetent adult with brain abscess caused by A. turicensis. A systematic review of A. turicensis infections was performed. METHODS: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases MEDLINE, Embase, Web of Science, CINAHL, Clinicaltrials.gov and Canadian Agency for Drugs and Technology in Health (CADTH) were searched for all relevant literature. RESULTS: Search identified 47 eligible records, for a total of 67 patients. A. turicensis infection was most frequently reported in the anogenital area (n = 21), causing acute bacterial skin and skin structure infections (ABSSSI) including Fournier's gangrene (n = 12), pulmonary infections (n = 8), gynecological infections (n = 6), cervicofacial district infections (n = 5), intrabdominal or breast infections (n = 8), urinary tract infections (n = 3), vertebral column infections (n = 2) central nervous system infections (n = 2), endocarditis (n = 1). Infections were mostly presenting as abscesses (n = 36), with or without concomitant bacteremia (n = 7). Fever and local signs of inflammation were present in over 60% of the cases. Treatment usually involved surgical drainage followed by antibiotic therapy (n = 51). Antimicrobial treatments most frequently included amoxicillin (+clavulanate), ampicillin/sulbactam, metronidazole or cephalosporins. Eighty-nine percent of the patients underwent a full recovery. Two fatal cases were reported. CONCLUSIONS: To the best of our knowledge, we hereby present the first case of a brain abscess caused by A. turicensis and P. mirabilis. Brain involvement by A. turicensis is rare and may result from hematogenous spread or by dissemination of a contiguous infection. The infection might be difficult to diagnose and therefore treatment may be delayed. Nevertheless, the pathogen is often readily treatable. Diagnosis of actinomycosis is challenging and requires prompt microbiological identification. Surgical excision and drainage and antibiotic treatment usually allow for full recovery.

Robot-Guided Stereotactic Puncture and Drainage in the Treatment of Thalamic Abscess.

Brain abscess is rare in clinic, the reported incidence is only 0.4 to 0.90 per 100,000 population, and most of them have a history of prodromal infection. Headache and fever are the most common clinical symptoms, and only a few are accompanied by neurological disorders. For the treatment of brain abscess, the most commonly used treatment is stereotactic puncture drainage and antibacterial therapy. A patient with a left thalamic abscess with no history of prodromal infection was reported. Stereotactic puncture and drainage were performed under the guidance of the Ruimi robot. The bacterial culture of the abscess was Streptococcus constellation ( Streptococcus constellatus ). The patient was discharged after 4 weeks of antibacterial treatment with vancomycin. The patients were followed up half a year after the operation, the prognosis was good and there was no recurrence.

Aggregatibacter aphrophilus and Eikenella corrodens: a case of brain abscess.

We report a case of a 26-year-old female who developed a brain abscess that was strongly suspected to be caused by Staphylococcus epidermidis, A. aphrophilus, and E. corrodens species. In general, A. aphrophilus and E. corrodens, members of the HACEK group (Haemophilus spp., Aggregatibacter spp., C. hominis, E. corrodens, and K. kingae), have been associated with the development of endocarditis, meningitis, sinusitis, otitis media, pneumonia, osteomyelitis, peritonitis, and wound infections. Cerebral abscesses are a rare manifestation of these bacteria; only a few cases are described in the literature, generally related to the diffusion of these organisms through the bloodstream after a dental procedure or a heart disease. Our case is unique because the rarity of the infection site appeared apparently in absence of risk factors. The patient underwent surgery to drain the abscess and was subsequently put on intravenous antibiotic treatment with ceftriaxone, vancomycin, and metronidazole. After 6 months, brain imaging revealed that the lesion had disappeared. The patient achieved excellent results with this approach.

First case of Rhinocladiella mackenziei brain abscess in Turkey: Case report and review of the literature.

Rhinocladiella mackenziei is a highly neurotropic fungus, mainly reported from the Middle East. However, in recent years, there have been some cases from outside this region. We described an additional fatal case of R. mackenziei cerebral infection for the first time from Turkey and made a literature review of all previously reported cases. During 34 years (1988-2022), there have been 42 R. mackenziei brain abscess cases. Most patients have been reported from Saudi Arabia (n = 14, 33.3%). It is noteworthy that 40.5% of patients, including our case, were immunocompetent at initial diagnosis and mostly presented with a single lesion (n = 10, 23.8%). The most frequent comorbidities were solid organ transplant (n = 9, 21.4%), diabetes mellitus (n = 6, 14.3%), malignancy (n = 6, 14.3%) and prior surgery (n = 3, 7.1%). The most commonly used initial antifungal regimen were amphotericin B together with itraconazole (n = 9, 21.4%), combinations of lipid preparations of amphotericin B, voriconazole and/or posaconazole (n = 9, 21.4%) and amphotericin B alone (n = 8, 19%). Although both surgical procedures and antifungal medication in the majority of patients were performed, mortality rates remained high (90.4%). The area at risk of R. mackenziei cerebral abscess cases extends to other countries. Clinicians should be aware of this emerging disease and take a detailed travel history in patients with atypical and undocumented brain abscesses. Our case confirms the hypothesis that this fungus might spread more widely than previously predicted regions.

Brain abscess caused by Paenibacillus lactis.

We present a case of a 30-year-old male patient who was admitted to our institution with a 4-month history of persistent headache, pain in the left half of the face and the left ear. The initial magnetic resonance imaging detected an inflammatory process in the left pyramid interpreted as petrous apicitis. Subsequently, he developed generalized seizures. Follow-up computed tomography scanning with contrast enhancement demonstrated newly-formed brain abscess in the basal region of the left temporal lobe. The patient underwent microsurgical evacuation and resection of the abscess. Microbiological examination isolated Paenibacillus lactis as a causative microorganism. During the postoperative period, the patient further developed life-threatening meningitis that was successfully managed with prolonged intravenous antimicrobial treatment. Six-months follow-up examination confirmed complete neurological recovery with no signs of recurrence based on Magnetic Resonance Imaging (MRI). To the best of our knowledge, this is the first reported case of brain abscess caused by Paenibacillus lactis in the medical literature.

Complex Lemierre syndrome with multisystemic abscesses.

We present here the challenging case of severe Lemierre syndrome in a healthy woman in her late twenties, whose clinical presentation was characterised by lung abscesses and disseminated systemic abscesses in the brain, the abdomen and the soft-tissues, as a likely consequence of a patent foramen ovale. Blood cultures were positive for Fusobacterium necrophorum and a right lingual vein thrombosis was detected at a late stage when the patient developed a septic shock. Initial antimicrobial therapy with metronidazole and ceftriaxone was modified to meropenem due to progressive worsening. The patient underwent laparoscopy and neurosurgical drainage of a cerebral abscess. She spent many days in the intensive care unit and recovered fully after 6 weeks on meropenem therapy. Although considered rare, the incidence of Lemierre syndrome, a potentially life-threatening condition, is increasing. The clinician should promptly recognise and treat it while being aware of its potential atypical presentations.

Nodulisporium Fungal Brain Abscess In Early Post-Renal Transplant: A Rare, Unexpected, Mysterious Pathogen.

BACKGROUND Central nervous system fungal infections are rarely encountered in current medicine, with fungal abscesses even less commonly seen. Clinical entities and their development largely depend on the interplay between the host's immune system and fungal virulence factors. Due to the large size of fungal organisms, they are prevented from entering the meningeal circulation. Hence, they cause focal diseases like cerebritis, abscesses, vasculitis of larger vessels, vascular occlusion, cerebral infarcts, and aneurysms. CASE REPORT A 34-year-old male patient of Indian descent diagnosed with stage 5 chronic kidney disease, bilaterally small kidneys, and hypertension underwent cadaveric renal transplantation and subsequent immunosuppression. Three months later, he returned with complaints of high-grade fever with chills and rigor, along with massive headaches. Plain brain computed tomography showed an intra-axial heterogeneously hypodense area with a hyperdense rim in the right temporal lobe. MRI revealed a well-defined enhancing lesion with irregular crenated margins and satellite lesions. Abscess wall biopsy showed fragments of hyaline septate filamentous fungal hyphae. Craniotomy with excision and drainage of the abscess was done and sent for histopathological examination along with culture. The results showed the growth of Nodulisporium fungus. The patient was then managed on amphotericin B and voriconazole for completion of treatment. CONCLUSIONS This is the first case reported of a Nodulisporium species fungal abscess developing in the brain after cadaveric kidney transplantation. Urgent evaluation via imaging and biopsy is crucial in determining the exact causal organism of brain abscesses, which can lead to better patient outcomes.

Brain abscess caused by Parvimonas micra: A rare case report and literature review.

Brain abscesses mostly develop due to direct infection caused by a nearby infectious lesion or hematogenous spread and are rarely caused by an odontogenic infection. We report a 47-year-old woman who presented with high fever, disturbed consciousness, headache, and neck pain. Imaging studies revealed a ring-shaped enhanced mass in the left frontal lobe causing a mass effect and midline shift. Magnetic resonance spectroscopy revealed a peak alanine concentration of 1.5 ppm. Supraorbital keyhole surgery with abscess removal was performed, and a bacterial culture confirmed a diagnosis of Parvimonas micra infection. After undergoing 6-week antibiotic treatment, the patient's symptoms resolved completely. No recurrence of abscess was observed during the follow-up period. Although brain abscess caused by P. micra has rarely been reported, an odontogenic origin should be investigated, especially when a patient has a history of periodontal infection or tooth extraction.

Clostridium septicum brain abscess.

We present a previously well woman in her 70s who was admitted for 2 weeks of progressively worsening abdominal pain, high fever and drowsiness. She was eventually diagnosed with Clostridium septicum brain abscess, meningoencephalitis and ventriculitis. The diagnosis was challenging as cerebrospinal fluid cultures were negative and a microbiological diagnosis was only obtained on brain biopsy. Despite early initiation of antibiotics that would have been effective against C. septicum, her central nervous system (CNS) infection progressed, and she eventually succumbed to the infection. Infections with C. septicum are typically fulminant and associated with high mortality. In a patient with a CNS infection and concomitant abdominal manifestations, infection with C. septicum should be considered.

Brain Abscesses Caused by Nocardia farcinica in a 44-Year Old Woman with Multiple Myeloma: A Rare Case and Review of the Literature.

BACKGROUND Central nervous system infection by the Nocardia species is associated with high morbidity and mortality. Its occurrence in patients with multiple myeloma is rare and acquisition of the infection in such patients was associated with the use of novel therapeutic agents (eg, bortezomib and lenalidomide) or bone marrow transplantation. Here, we report the first case of Nocardia brain abscesses in a patient with multiple myeloma, without the above risk factors. CASE REPORT A 44-year-old woman with IgG-kappa type multiple myeloma presented with generalized tonic-clonic seizures. Magnetic resonance imaging of the brain revealed 3 space-occupying lesions in left frontal, left parietal, and right parietal regions. Craniotomy and enucleation of the left frontal lesion revealed an abscess. The culture result was Nocardia farcinica. The patient was treated with meropenem, amikacin, and trimethoprim-sulfamethoxazole for 6 weeks, followed by trimethoprim-sulfamethoxazole for 12 months, with good outcome. CONCLUSIONS Cerebral nocardiosis is a rare entity and its occurrence in our case may hint toward myeloma-associated humoral immune dysfunction as a pathogenesis and the importance of humoral immunity in the defense against this infection. However, chemotherapy-induced cell-mediated dysfunction cannot be ruled out as a risk factor for the infection. Despite its rarity, this case aims to raise awareness of the condition and reiterate the importance of considering the rare but life-threatening conditions in the differential diagnosis of brain lesions, especially when there is a misdiagnosis of the radiological findings, as occurred in this and previous cases; this avoids delays in appropriate surgical and medical treatment, which can affect outcomes.

Central nervous system infection by Bacillus cereus: a case report and literature review. / Infección del sistema nervioso central por Bacillus cereus: descripción de un caso y revisión de la bibliografía.

INTRODUCTION: Bacillus cereus is a ubiquitous pathogen that usually produces self-limiting gastrointestinal symptoms. However, in susceptible patients, it can lead to central nervous system infections which are potentially fatal. DEVELOPMENT: We present the case of a 10-year-old male under chemotherapy treatment for acute lymphoblastic leukemia. During the induction period he developed a brain abscess due to B. cereus which was diagnosed through imaging tests and direct detection in the cerebrospinal fluid. His evolution was favorable with antibiotic treatment. CONCLUSIONS: So far, 26 other cases of central nervous system infections due to B. cereus have been described in literature, and besides being infrequent, they are a diagnostic challenge. However, in preterm infants, patients with hematological malignancies or central nervous system surgery, early suspicion should be established to start an appropriate antibiotic treatment and improve prognosis.

TITLE: Infección del sistema nervioso central por Bacillus cereus: descripción de un caso y revisión de la bibliografía.Introducción. Bacillus cereus es un patógeno ubicuo que, habitualmente, produce síntomas gastrointestinales autolimitados. Sin embargo, en pacientes susceptibles, puede dar lugar a infecciones del sistema nervioso central potencialmente mortales. Desarrollo. Presentamos el caso de un varón de 10 años en tratamiento quimioterápico por leucemia linfoblástica aguda. Durante el período de inducción desarrolló un absceso cerebral por B. cereus que fue diagnosticado mediante pruebas de imagen y detección directa en el líquido cefalorraquídeo. Su evolución fue favorable con tratamiento antibiótico. Conclusiones. Hasta ahora se han descrito en la bibliografía otros 26 casos de infección del sistema nervioso central por B. cereus, que, además de ser infrecuentes, suponen un reto diagnóstico. Sin embargo, en los recién nacidos prematuros, en pacientes con neoplasias hematológicas o con antecedentes de cirugía del sistema nervioso central, debe establecerse una sospecha temprana para iniciar un tratamiento antibiótico adecuado que mejore el pronóstico.

Surgical aspiration versus excision for intraparenchymal abscess: a systematic review and Meta-analysis.

Brain abscesses are associated with considerable morbidity and mortality, requiring timely intervention to achieve favourable outcomes. With the advent of high-resolution computed tomography (CT) imaging, mortality following both aspiration and excision of brain abscesses has improved markedly. As a result, there has been a marked shift in neurosurgical practice with aspiration eclipsing excision as the favoured first-line modality for most abscesses. However, this trend lacks sufficient supporting evidence, and this systematic review and meta-analysis seeks to compare aspiration and excision in the treatment of brain abscess. Twenty-seven studies were included in the systematic review, and seven comparative papers in meta-analysis. Aspiration was the chosen technique for 67.5% of patients. Baseline characteristics from the studies included only in the systematic review demonstrated that abscesses treated by aspiration were typically larger and in a deeper location than those excised. In the meta-analysis, we initially found no significant difference in mortality, re-operation rate, or functional outcome between the two treatment modalities. However, sensitivity analysis revealed that excision results in lower re-operation rate. On average, the included studies were of poor quality with average Methodological Index for Non-Randomized Studies (MINORS) scores of 10.3/16 and 14.43/24 for non-comparative and comparative papers respectively. Our study demonstrates that excision may offer improved re-operation rate as compared to aspiration for those abscesses where there is no prior clinical indication for either modality. However, no differences were found with respect to mortality or functional outcome. Evidence from the literature was deemed low quality, emphasizing the need for further investigation in this field, specifically in the form of large, well-controlled, comparative trials.