Treatment for a brain abscess will depend on the size and number of brain abscesses present. A brain abscess is a medical emergency, so you will need to have treatment in hospital and will stay there until your condition is stable.

Medication

Surgery will be avoided if it is thought to be too risky or if an abscess is small and could be treated by medication alone.

Medication is recommended over surgery if you have:

• several abscesses
• a small abscess (less than 2cm)
• an abscess deep inside the brain
• meningitis as well as an abscess
• hydrocephalus (a build-up of fluid on the brain)

You will normally be given antibiotics or antifungal medication through a drip (directly into a vein). Doctors will aim to treat the abscess and the original infection that caused it.

Surgery

If the abscess is larger than 2cm, it is usually necessary to drain the pus out of the abscess (open aspiration) or cut the abscess out of the brain tissue (excision).

Open aspiration and excisions are usually carried out using a surgical procedure known as a craniotomy.

During a craniotomy, the surgeon will shave a small section of your hair and then remove a small piece of your skull bone (a bone flap) to gain access to your brain.

The abscess will then be drained of pus or totally removed. A CT-guided localisation system may be used during the operation, which allows the surgeon to more accurately locate the exact position of the abscess.

Once the abscess has been treated, the bone is replaced and held in position with small metal screws to prevent movement and encourage better healing. The operation usually takes between four and six hours, which includes recovery from the general anaesthetic (where you are put to sleep).

Complications of a craniotomy

As with all surgery, a craniotomy carries risks, but serious complications are uncommon.

Possible complications of a craniotomy are:

• Swelling and bruising around your face, which is common after a craniotomy. This will die down after the operation.
• Headaches. These are common after a craniotomy and may last for several months, but should eventually settle down.
• A blood clot in the brain (further surgery may be required to remove it).
• Stiff jaw. During a craniotomy, the surgeon may need to make a small cut to a muscle that helps with chewing. The muscle does heal, but can become stiff for a few months, causing your jaw to feel stiff. Exercising the muscle by regularly chewing sugar-free gum should help relieve the stiffness.
• Movement of the bone flap. The bone flap in your skull may feel like it moves and you may experience a clicking sensation. This can feel strange, but it is normal and not dangerous. It will stop as the skull heals.

The site of the incision (cut) in your skull can become infected, although this is uncommon. You are usually given antibiotics around the time of your operation to prevent infection.