Surgical treatment of patients with secondary brain abscess after emergency craniotomy in adults: a single-center retrospective study.

Although advancements have been made in the diagnosis and management of brain abscesses, associated morbidity and mortality remain substantial. Secondary brain abscesses following emergency craniotomy may aggravate primary brain injury and lead to increased disability and complications. This single-center retrospective study evaluated adult patients diagnosed with secondary brain abscesses between June 2015 and June 2025. A total of 47 patients were included, with a mean age of 54.6 ± 15.1 years, and 35 patients (74.5%) were male. All patients had a history of intracerebral hemorrhage (55.3%) or traumatic brain injury (44.7%) and underwent emergency craniotomy. Contrast-enhanced magnetic resonance imaging (MRI) and/or computed tomography (CT) were performed in all cases. The most common clinical manifestations were fever (42.6%), headache (36.2%), and cognitive impairment (19.1%), while focal neurological deficits such as hemiplegia were frequently observed due to the primary injury. The mean Glasgow Coma Scale (GCS) score improved significantly from 11.7 ± 2.0 before treatment to 13.2 ± 1.5 after treatment. According to the Glasgow Outcome Scale at discharge, 44 patients (93.6%) achieved good outcomes, whereas 3 patients (6.4%) had poor outcomes. Lower GCS scores at presentation were associated with unfavorable prognosis. Timely surgical intervention combined with targeted antimicrobial therapy effectively controlled infection and reduced the risk of permanent neurological deficits.