COMPARISON OF SURGICAL OUTCOMES BETWEEN CONVENTIONAL BURR HOLE ASPIRATION AND ENDOSCOPE-ASSISTED EVACUATION OF BRAIN ABSCESS

Abstract

Objective: This study aimed to conduct a comprehensive comparison of surgical outcomes between conventional burr hole aspiration and endoscope-assisted evacuation techniques for solitary brain abscesses, evaluating both radiological efficacy and clinical recovery parameters.

Study Design: A prospective, single-center, randomized controlled trial with parallel group design.

Place and Duration of Study: The study was conducted at the Department of Neurosurgery, Bahawal Victoria Hospital, Bahawalpur, from  December 2024 to May 2025.

Methodology: Twenty-four patients with radiologically confirmed solitary brain abscesses measuring ≥2 cm³ were enrolled through consecutive sampling and randomly allocated into two equal groups using a computer-generated randomization sequence with sealed envelope concealment. Group A (n=12) underwent conventional burr hole aspiration with stereotactic guidance, while Group B (n=12) underwent minimally invasive endoscope-assisted evacuation using a 4mm rigid neuroendoscope.

Results: The cohort demonstrated homogeneous baseline characteristics with no significant demographic or clinical differences between groups. The endoscopic group exhibited superior radiological outcomes with a mean residual volume of 0.9 ± 0.4 ml compared to 1.9 ± 0.6 ml in the conventional group (p < 0.01). Successful evacuation (≥75%) was achieved in 91.7% of endoscopic cases versus 66.7% of conventional aspirations (p < 0.05). Clinically, the endoscopic approach eliminated the need for re-operation (0% vs. 33.3%, p < 0.05) and reduced mean hospitalization duration by approximately 30% (7.4 ± 1.2 days vs. 10.2 ± 2.1 days, p < 0.05).

Conclusion: Endoscope-assisted evacuation represents a technically superior surgical strategy for solitary brain abscess management, offering significantly enhanced complete evacuation rates, reduced re-intervention requirements, accelerated neurological recovery, and shorter hospital stays compared to conventional burr hole aspiration, without compromising procedural safety.