My sister has a brain abscess that originally was located in the center of the brain and she developed spinal meningitis. A week ago, the CAT scan showed the abscess had moved to the “right ventricle”. The doctors are puzzled about the bacteria and are unable to find out what the bacteria is and have sent something from Alberta Canada to Toronto ON to find out what it might be. The results are not back yet from Toronto. Now the doctors are talking about doing surgery to take out the abscess and do a biopsy but not for a while yet.

My questions are:

1. What is the material that was sent to Toronto?
2. The material that was sent to Toronto, is that the same material as what the biopsy would be; in other words, the stuff that was sent to Toronto, would that not have been a withdrawal of fluid or whatever to do a biopsy so why would it warrant another biopsy if they take out the abscess?
3. Why have they not done surgery yet, either when the abscess was in the center of the brain and now in the right ventricle?
4. What and where is the right ventricle of the brain? Is there a picture somewhere?
5. If surgery is performed, is this serious enough that it would warrant that I go to be with my sister in case something goes wrong?
6. What could go wrong if she goes in for surgery?
7. Is there anything else that you can tell me about this condition??
8. Could it be the spinal fluid they sent to Toronto?

Doctor Joshua’s Answer: Brain Abscess and Brain Surgery

Thank you for your question. First of all I have to say that you should be presenting these very good questions to the attending doctors. They are the only ones who can give you specific answers.

I’ll try to give you some helpful information and discuss your questions on a general level - I cannot comment on your sister’s specific case because I don’t have sufficient details.

From your description it is not entirely clear to me whether any kind of biopsy has been done, if not, it seems likely that the sample is cerebro-spinal fluid and/or blood. If the doctors have found a local infection in some other location in her body (some of the more common origins of brain abscess including teeth, middle ear, sinuses…), they may have taken samples from that. If the brain abscess has been biopsied, they would have sent samples from the biopsy, which is usually pus (yellowish material containing bacteria and white blood cells).

If a biopsy has been done, and it was unsuccessful in producing a diagnosis, then another biopsy may be needed to produce a better sample.

If a biopsy has not been done, and there is no growth in samples from cerebro-spinal fluid or blood or elsewhere in the body, then a biopsy is needed to produce a sample which contains the bacteria or other micro-organisms that might cause the brain abscess.

Sometimes, differentiating between a brain abscess and certain types of brain tumor is very difficult without a biopsy. MRI or even spectroscopy cannot always tell the difference. Certain types of brain tumors require removal by surgery, certain other types of brain tumors may be treated with radiation or chemotherapy without surgery, and also in some cases a brain abscess is better treated with biopsy plus drainage plus antibiotics, and in some cases removal by surgery is required.

Generally, the deeper and more close to midline the brain abscess or tumor is, the better it is to avoid radical surgery because the risk of producing neurological deficits is greater with surgery near deep and midline structures. In such a case, stereotactic biopsy is often performed - the brain abscess can also be drained during the same procedure, which is an important part of the treatment.

See the below link to the Wikipedia entry in which the lateral ventricle is explained. The lateral ventricle is a part of the cerebro-spinal fluid system, and encompasses a fairly large area so an abscess close to the right lateral ventricle could be located in various anatomical places inside the brain - I cannot deduce the exact location of the abscess from the knowledge that it is close to the right lateral ventricle.

Brain surgery is always serious, and while modern brain surgery has a high success rate with a reasonably low risk of permanent neurological damage, the risks are there, and while I cannot decide these things for you, I’ll just say that if my sister were to have brain surgery, I would choose to be present before and after the surgery.

http://en.wikipedia.org/wiki/Lateral_ventricles

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