Stereotactic neuronavigation-assisted evacuation of intracranial abscess localized in the thalamus. A case report

Introduction: A brain abscess is a localized focal area of intracerebral infection that develops into a collection of pus surrounded by a well vascularized capsule. It has a rare incidence of 2% of all space occupying lesions and the deep-seated thalamus as a location is reported in 1.3 to 6% of all brain abscesses. The use of stereotactic neuronavigation-guided surgical evacuation is a minimally invasive option for achieving good treatment results. Materials and Methods: A 67-year-old female with constant headache, vertigo, staggering and muscle weakness for the right leg developed memory problems and confusion few days prior to admission in the Department of Neurosurgery. Upon examination, raised intracranial pressure, right-sided spastic hemiparesis, and memory and cognitive disturbance were present. The laboratory results showed leukocytosis, elevated glucose, cholesterol and C-reactive protein levels. A computed tomography (CT) scan showed a circular ring-like lesion localized in the region of the left thalamus that enhanced its peripheral hyperdensity after contrast application. Neuronavigation-assisted surgical evacuation was executed. A biopsy needle was inserted in the left thalamic region and the evacuated sample was sent for pathological and microbiological examinations. Results: The lesion was verified as an abscess and antibiotic therapy was prescribed for 20 days based upon the isolated bacterium and its sensitivity. Conclusion: An abscess localized in the deep-seated region of the brain is a diagnostic and therapeutic challenge. Frameless neuronavigation-guided surgical procedure is an elegant option for minimally invasive approach that allows evacuation and additional examination for correct diagnosis and effective treatment.