A case of brain abscess successfully treated with continuous irrigation therapy

Dear Editor,

I read with interest the case report, “A case of brain abscess successfully treated with continuous irrigation therapy,” by Takano et al., which was published in Surgical Neurology International in February 2025.[3] The report describes the successful treatment of a 62-year-old patient diagnosed with a cerebellar abscess and purulent meningitis. He was adequately treated with drainage of the abscess from a small craniotomy and systemic antibiotic therapy. In addition, continuous irrigation with saline containing gentamicin was performed, infused from the lateral ventricle through the cerebral cistern to the spinal drainage.

The authors present this treatment as a novel method to improve the prognosis of patients with a brain abscess. This idea is incorrect. Intraventricular administration of antibiotics or intraventricular irrigation is the treatment indicated for ventriculitis, either postsurgical or due to an abscess rupture.[1,2] Continuous irrigation and drainage using a double-lumen catheter can also be applied in cases of brain abscess.[4] In the reported case, there was no evidence of ventriculitis. Therefore, there is no logical justification for the use of irrigation through the lateral ventricle. If the abscess is located in the brain parenchyma and is enclosed by a capsule without communicating with the ventricles or cerebral cisterns, irrigating the cerebrospinal fluid (CSF) spaces has no significance for treatment and only carries a high risk of complications. Concomitant meningitis, which is often associated with a brain abscess, is adequately treated with systemic intravenous antibiotics, rather than irrigation of the CSF spaces. Furthermore, irrigating the CSF spaces from the ventricle through the cerebral cistern to the spinal drainage carries a high risk of disseminating the infection from the infected site to unaffected CSF spaces. Incorrect treatments cannot be published in a scientific journal as novel treatments.

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