Editing Brain abscess (section)

==Treatment==
The treatment includes lowering the increased intracranial pressure and starting intravenous [[antibiotic]]s (and meanwhile identifying the causative organism mainly by blood culture studies).{{cn|date=June 2022}}

[[Hyperbaric medicine|Hyperbaric oxygen therapy]] (HBO2 or HBOT) is indicated as a primary and adjunct treatment which provides four primary functions.
Firstly, HBOT reduces intracranial pressure.<ref>{{cite web|url=http://membership.uhms.org/?page=IA|title=Home|work=Undersea & Hyperbaric Medical Society|access-date=2014-07-16|archive-date=2014-07-26|archive-url=https://web.archive.org/web/20140726130336/http://membership.uhms.org/?page=IA|url-status=live}}</ref> Secondly, high partial pressures of oxygen act as a bactericide and thus inhibits the anaerobic and functionally anaerobic flora common in brain abscess. Third, HBOT optimizes the immune function thus enhancing the host defense mechanisms and fourth, HBOT has been found to be of benefit when brain abscess is concomitant with cranial osteomyelitis.

Secondary functions of HBOT include increased stem cell production and up-regulation of VEGF which aid in the healing and recovery process.<ref>{{cite journal | vauthors = Thom SR, Bhopale VM, Velazquez OC, Goldstein LJ, Thom LH, Buerk DG | title = Stem cell mobilization by hyperbaric oxygen | journal = American Journal of Physiology. Heart and Circulatory Physiology | volume = 290 | issue = 4 | pages = H1378–H1386 | date = April 2006 | pmid = 16299259 | doi = 10.1152/ajpheart.00888.2005 | s2cid = 29013782 }}</ref>

Surgical drainage of the abscess remains part of the standard management of bacterial brain abscesses.  The location and treatment of the primary lesion is also crucial, as is the removal of any foreign material (bone, dirt, bullets, and so forth).

There are few exceptions to this rule: ''[[Haemophilus influenzae]]'' meningitis is often associated with subdural effusions that are mistaken for subdural empyemas.  These effusions resolve with antibiotics and require no surgical treatment.  [[Tuberculosis]] can produce brain abscesses that look identical to conventional bacterial abscesses on CT imaging. Surgical drainage or aspiration is often necessary to identify ''[[Mycobacterium tuberculosis]]'', but once the diagnosis is made no further surgical intervention is necessary.

CT guided stereotactic aspiration is also indicated in the treatment of brain abscess. The use of pre-operative imaging, intervention with post-operative clinical and biochemical monitoring used to manage brain abscesses today dates back to the Pennybacker system pioneered by [[Somerset, Kentucky]]-born neurosurgeon Joseph Buford Pennybacker, director of the neurosurgery department of the [[Radcliffe Infirmary]], [[Oxford]] from 1952 to 1971. <ref>{{cite journal | vauthors = Visagan R, Ellis H | title = Joseph Buford Pennybacker, C.B.E., M.D., F.R.C.S. (1907-1983): Continuing Sir Hugh Cairns' Oxford Legacy and Pioneer of the Modern Management of Cerebral Abscesses | journal = World Neurosurgery | volume = 104 | pages = 339–345 | date = August 2017 | pmid = 28185969 | doi = 10.1016/j.wneu.2017.01.113 | s2cid = 34618814 | url = https://kclpure.kcl.ac.uk/portal/en/publications/joseph-buford-pennybacker-cbe-md-frcs-19071983-continuing-sir-hugh-cairns-oxford-legacy-and-pioneer-of-the-modern-management-of-cerebral-abscesses(4f38ac76-0cb3-433a-94aa-68963412b9e9).html | access-date = 2020-06-05 | archive-date = 2020-06-11 | archive-url = https://web.archive.org/web/20200611190503/https://kclpure.kcl.ac.uk/portal/en/publications/joseph-buford-pennybacker-cbe-md-frcs-19071983-continuing-sir-hugh-cairns-oxford-legacy-and-pioneer-of-the-modern-management-of-cerebral-abscesses(4f38ac76-0cb3-433a-94aa-68963412b9e9).html | url-status = live }}</ref>