{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T22:51:14Z","timestamp":1789512674970,"version":"build-2803163510"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Brain abscesses are severe infections with high morbidity and mortality. Surgical drainage is essential, but the optimal technique remains unclear. The aim of this multicenter study was to compare navigated\/stereotactic aspiration and microsurgical resection in terms of reoperation rates, clinical outcomes, and surgery-related complications in patients with primary pyogenic brain abscess.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A multicentric retrospective analysis was conducted across 5 university centers in Germany and Austria, and included patients who underwent surgery for primary pyogenic brain abscesses from January 2008 to December 2023. Exclusion criteria were previous head surgery or trauma, lack of preoperative MRI, multiple abscesses, concomitant subdural empyema, and infratentorial or deep-seated abscesses (&gt; 2 cm from the cortical surface). The primary endpoint was reoperation for the abscess, while secondary endpoints included unfavorable clinical outcomes (modified Rankin Scale [mRS] score \u2265 3) at discharge, 3 months, and 6 months after surgery and surgery-related complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 148 patients (102 male, mean age 49.1 years) included in the analysis, 82 (55.4%) underwent microsurgical resection and 66 (44.6%) underwent aspiration. Reoperations were significantly more frequent in the aspiration group (39.4%) than in the resection group (20.7%) (p = 0.018). Surgical complication rates did not differ significantly. A significant improvement in clinical status (median mRS score of 1) was observed in both the aspiration and resection groups (p &lt; 0.001 each) after surgery, with 26 patients (17.6%) still having an mRS score \u2265 3 at discharge. In the aspiration group, no further improvement was noted between hospital discharge and the 3-month follow-up (p = 0.34), but significant improvement occurred between the 3- and 6-month follow-up evaluations (p = 0.02). In contrast, patients in the resection group showed significant improvement between discharge and the 3-month follow-up (p &lt; 0.001), with no additional improvement observed between 3 and 6 months (p = 0.49). Five in-hospital deaths occurred, all in the aspiration group, resulting in an overall mortality of 3.4% (p = 0.005).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Aspiration was linked to an increased reoperation rate and higher in-hospital mortality, although surgical complication rates were similar. Patients in both groups had comparable favorable outcomes at discharge and at 3- and 6-month follow-up evaluations. Patients who underwent open resection showed faster early recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.focus25662","type":"journal-article","created":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T12:05:40Z","timestamp":1761998740000},"page":"E11","source":"Crossref","is-referenced-by-count":3,"title":["Evaluation of aspiration versus microsurgical resection for primary superficial pyogenic brain abscesses: results from a German-Austrian retrospective multicenter study"],"prefix":"10.3171","volume":"59","author":[{"given":"Thomas","family":"Eibl","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Ritter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Matejka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Paracelsus Medical University, Christian Doppler Clinic, Salzburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos M.","family":"Beredjiklian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Paracelsus Medical University, Christian Doppler Clinic, Salzburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph J.","family":"Griessenauer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Paracelsus Medical University, Christian Doppler Clinic, Salzburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Brunner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University Graz, Austria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"Freigang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University Graz, Austria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Schnell","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen N\u00fcrnberg, Erlangen; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Vladimirov","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen N\u00fcrnberg, Erlangen; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Maiwald","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen N\u00fcrnberg, Erlangen; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Schachinger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils O.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl M.","family":"Schebesch","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Liebert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"7-8","key":"b1","series-title":"Rev Neurol (Paris)","first-page":"469","article-title":"Brain abscess in immunocompetent adult patients","volume":"175","author":"Cantiera M","year":"2019","unstructured":"Cantiera M, Tattevin P, Sonneville R. Brain abscess in immunocompetent adult patients. Rev Neurol (Paris). 2019;175(7-8):469\u2013474."},{"issue":"4","key":"b2","series-title":"Clin Infect Dis","first-page":"763","article-title":"Brain abscess","volume":"25","author":"Mathisen GE","year":"1997","unstructured":"Mathisen GE, Johnson JP. Brain abscess. Clin Infect Dis. 1997;25(4):763\u2013781."},{"key":"b3","series-title":"BMC Infect Dis","first-page":"332","article-title":"Pyogenic brain abscess, a 15 year survey","volume":"12","author":"Helweg-Larsen J","year":"2012","unstructured":"Helweg-Larsen J, Astradsson A, Richhall H, Erdal J, Laursen A, Brennum J. Pyogenic brain abscess, a 15 year survey. BMC Infect Dis. 2012;12:332."},{"issue":"1","key":"b4","series-title":"J Neurol Surg A Cent Eur Neurosurg","first-page":"12","article-title":"Brain abscess: a comparison of surgical outcomes between conventional burr hole aspiration and endoscope-assisted evacuation","volume":"86","author":"Ahmed MF","year":"2025","unstructured":"Ahmed MF, Rana S, Zahan KFI,  Brain abscess: a comparison of surgical outcomes between conventional burr hole aspiration and endoscope-assisted evacuation. J Neurol Surg A Cent Eur Neurosurg. 2025;86(1):12\u201316."},{"issue":"1","key":"b5","series-title":"Clin Microbiol Infect","first-page":"95","article-title":"Incidence and mortality of brain abscess in Denmark: a nationwide population-based study","volume":"26","author":"Bodilsen J","year":"2020","unstructured":"Bodilsen J, Dalager-Pedersen M, van de Beek D, Brouwer MC, Nielsen H. Incidence and mortality of brain abscess in Denmark: a nationwide population-based study. 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Malays J Med Sci. 2010;17(1):23\u201329."},{"issue":"4","key":"b12","series-title":"Br J Neurosurg","first-page":"412","article-title":"Never go to sleep on undrained pus: a retrospective review of surgery for intraparenchymal cerebral abscess","volume":"23","author":"Smith SJ","year":"2009","unstructured":"Smith SJ, Ughratdar I, MacArthur DC. Never go to sleep on undrained pus: a retrospective review of surgery for intraparenchymal cerebral abscess. Br J Neurosurg. 2009;23(4):412\u2013417."},{"issue":"1","key":"b13","series-title":"Clin Microbiol Infect","first-page":"66","article-title":"European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults","volume":"30","author":"Bodilsen J","year":"2024","unstructured":"Bodilsen J, D\u2019Alessandris QG, Humphreys H,  European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect. 2024;30(1):66\u201389."},{"issue":"1","key":"b14","series-title":"J Neurosurg","first-page":"133","article-title":"William Macewen and the treatment of brain abscesses: revisited after one hundred years","volume":"84","author":"Canale DJ","year":"1996","unstructured":"Canale DJ. William Macewen and the treatment of brain abscesses: revisited after one hundred years. 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Acta Clin Croat. 2021;60(4):559\u2013568."},{"issue":"1","key":"b17","series-title":"Br J Neurosurg","first-page":"29","article-title":"Surgical outcome of encapsulated brain abscess in superficial non-eloquent area: a systematic review","volume":"30","author":"Zhai Y","year":"2016","unstructured":"Zhai Y, Wei X, Chen R, Guo Z, Raj Singh R, Zhang Y. Surgical outcome of encapsulated brain abscess in superficial non-eloquent area: a systematic review. Br J Neurosurg. 2016;30(1):29\u201334."},{"key":"b18","series-title":"World Neurosurg","first-page":"e697","article-title":"Retrospective review of the clinical outcomes of surgically managed patients with intracranial abscesses: a single-center review","volume":"165","author":"Kameda-Smith MM","year":"2022","unstructured":"Kameda-Smith MM, Duda T, Duncan DB,  Retrospective review of the clinical outcomes of surgically managed patients with intracranial abscesses: a single-center review. 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Surg Neurol Int","volume":"4","author":"Gadgil N","year":"2013","unstructured":"Gadgil N, Patel AJ, Gopinath SP. Open craniotomy for brain abscess: a forgotten experience? Surg Neurol Int. 2013;4:34."},{"issue":"1","key":"b22","series-title":"Acta Neurochir (Wien)","first-page":"140","article-title":"Influence of laboratory and radiographic parameters on the clinical presentation and outcome of surgically treated patients with primary brain abscesses","volume":"167","author":"Liebert A","year":"2025","unstructured":"Liebert A, Eibl T, Lukin D,  Influence of laboratory and radiographic parameters on the clinical presentation and outcome of surgically treated patients with primary brain abscesses. Acta Neurochir (Wien). 2025;167(1):140."},{"issue":"7-8","key":"b1","series-title":"Rev Neurol (Paris)","first-page":"469","article-title":"Brain abscess in immunocompetent adult patients","volume":"175","author":"Cantiera M","year":"2019","unstructured":"Cantiera M, Tattevin P, Sonneville R. 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BMC Infect Dis. 2012;12:332."},{"issue":"1","key":"b4","series-title":"J Neurol Surg A Cent Eur Neurosurg","first-page":"12","article-title":"Brain abscess: a comparison of surgical outcomes between conventional burr hole aspiration and endoscope-assisted evacuation","volume":"86","author":"Ahmed MF","year":"2025","unstructured":"Ahmed MF, Rana S, Zahan KFI,  Brain abscess: a comparison of surgical outcomes between conventional burr hole aspiration and endoscope-assisted evacuation. J Neurol Surg A Cent Eur Neurosurg. 2025;86(1):12\u201316."},{"issue":"1","key":"b5","series-title":"Clin Microbiol Infect","first-page":"95","article-title":"Incidence and mortality of brain abscess in Denmark: a nationwide population-based study","volume":"26","author":"Bodilsen J","year":"2020","unstructured":"Bodilsen J, Dalager-Pedersen M, van de Beek D, Brouwer MC, Nielsen H. Incidence and mortality of brain abscess in Denmark: a nationwide population-based study. Clin Microbiol Infect. 2020;26(1):95\u2013100."},{"issue":"4","key":"b6","series-title":"Brain","first-page":"1637","article-title":"Clinical features and prognostic factors in adults with brain abscess","volume":"146","author":"Bodilsen J","year":"2023","unstructured":"Bodilsen J, Duerlund LS, Mariager T,  Clinical features and prognostic factors in adults with brain abscess. Brain. 2023;146(4):1637\u20131647."},{"issue":"9","key":"b7","series-title":"Neurology","first-page":"806","article-title":"Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis","volume":"82","author":"Brouwer MC","year":"2014","unstructured":"Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. 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Int J Infect Dis. 2022;115:189\u2013194."},{"issue":"6","key":"b10","series-title":"Clin Radiol","first-page":"564","article-title":"Bacterial brain abscesses: prognostic value of an imaging severity index","volume":"62","author":"Demir MK","year":"2007","unstructured":"Demir MK, Hakan T, Kilicoglu G,  Bacterial brain abscesses: prognostic value of an imaging severity index. Clin Radiol. 2007;62(6):564\u2013572."},{"issue":"1","key":"b11","series-title":"Malays J Med Sci","first-page":"23","article-title":"Treatment outcome of superficial cerebral abscess: an analysis of two surgical methods","volume":"17","author":"Tan WM","year":"2010","unstructured":"Tan WM, Adnan JS, Mohamad Haspani MS. Treatment outcome of superficial cerebral abscess: an analysis of two surgical methods. Malays J Med Sci. 2010;17(1):23\u201329."},{"issue":"4","key":"b12","series-title":"Br J Neurosurg","first-page":"412","article-title":"Never go to sleep on undrained pus: a retrospective review of surgery for intraparenchymal cerebral abscess","volume":"23","author":"Smith SJ","year":"2009","unstructured":"Smith SJ, Ughratdar I, MacArthur DC. Never go to sleep on undrained pus: a retrospective review of surgery for intraparenchymal cerebral abscess. Br J Neurosurg. 2009;23(4):412\u2013417."},{"issue":"1","key":"b13","series-title":"Clin Microbiol Infect","first-page":"66","article-title":"European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults","volume":"30","author":"Bodilsen J","year":"2024","unstructured":"Bodilsen J, D\u2019Alessandris QG, Humphreys H,  European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect. 2024;30(1):66\u201389."},{"issue":"1","key":"b14","series-title":"J Neurosurg","first-page":"133","article-title":"William Macewen and the treatment of brain abscesses: revisited after one hundred years","volume":"84","author":"Canale DJ","year":"1996","unstructured":"Canale DJ. William Macewen and the treatment of brain abscesses: revisited after one hundred years. J Neurosurg. 1996;84(1):133\u2013142."},{"issue":"6","key":"b15","series-title":"Br J Neurosurg","first-page":"743","article-title":"Surgical aspiration versus excision for intraparenchymal abscess: a systematic review and meta-analysis","volume":"36","author":"Lannon M","year":"2022","unstructured":"Lannon M, Trivedi A, Martyniuk A, Farrokhyar F, Sharma S. Surgical aspiration versus excision for intraparenchymal abscess: a systematic review and meta-analysis. Br J Neurosurg. 2022;36(6):743\u2013749."},{"issue":"4","key":"b16","series-title":"Acta Clin Croat","first-page":"559","article-title":"Does the type of surgery in brain abscess patients influence the outcome? Analysis based on the propensity score method","volume":"60","author":"Penezi\u0107 A","year":"2021","unstructured":"Penezi\u0107 A, Santini M, Heinrich Z, Chudy D, Mikli\u0107 P, Bar\u0161i\u0107 B. Does the type of surgery in brain abscess patients influence the outcome? Analysis based on the propensity score method. Acta Clin Croat. 2021;60(4):559\u2013568."},{"issue":"1","key":"b17","series-title":"Br J Neurosurg","first-page":"29","article-title":"Surgical outcome of encapsulated brain abscess in superficial non-eloquent area: a systematic review","volume":"30","author":"Zhai Y","year":"2016","unstructured":"Zhai Y, Wei X, Chen R, Guo Z, Raj Singh R, Zhang Y. Surgical outcome of encapsulated brain abscess in superficial non-eloquent area: a systematic review. Br J Neurosurg. 2016;30(1):29\u201334."},{"key":"b18","series-title":"World Neurosurg","first-page":"e697","article-title":"Retrospective review of the clinical outcomes of surgically managed patients with intracranial abscesses: a single-center review","volume":"165","author":"Kameda-Smith MM","year":"2022","unstructured":"Kameda-Smith MM, Duda T, Duncan DB,  Retrospective review of the clinical outcomes of surgically managed patients with intracranial abscesses: a single-center review. World Neurosurg. 2022;165:e697\u2013e711."},{"issue":"46","key":"b19","series-title":"Medicine (Baltimore)","first-page":"e17670","article-title":"Retrospective analysis of brain abscess in 183 patients: A 10-year survey","volume":"98","author":"Wu S","year":"2019","unstructured":"Wu S, Wei Y, Yu X,  Retrospective analysis of brain abscess in 183 patients: A 10-year survey. Medicine (Baltimore). 2019;98(46):e17670."},{"issue":"6","key":"b20","series-title":"Surg Neurol","first-page":"557","article-title":"Brain abscess in 142 patients: factors influencing outcome and mortality","volume":"65","author":"Tseng JH","year":"2006","unstructured":"Tseng JH, Tseng MY. Brain abscess in 142 patients: factors influencing outcome and mortality. Surg Neurol. 2006;65(6):557\u2013562."},{"key":"b21","first-page":"34","article-title":"Open craniotomy for brain abscess: a forgotten experience? 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