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 treatment in hospital until your condition is stable.

Medication

Surgery will be avoided if thought 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 (an infection of the protective membranes that surround the brain) 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.

There are two surgical techniques for treating a brain abscess:

• simple aspiration
• craniotomy

Simple aspiration involves using a CT scan to locate the abscess, then drilling a small hole known as a "burr hole" into the skull. The pus is then drained through the hole and the hole sealed.

A simple aspiration takes around one hour to complete.

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

Craniotomy

A craniotomy may be recommended if an abscess does not respond to aspiration or reoccurs at a later date.

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. The operation usually takes around three 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 described below: 

• Swelling and bruising around your face, which is common after a craniotomy. This will lessen after the operation.
• Headaches. These are common after a craniotomy and may last 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 heals, 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 cut (incision) in your skull can become infected, although this is uncommon. You are usually given antibiotics around the time of your operation to prevent infection.

Recovering from surgery

Once your brain abscess has been treated, you will probably stay in hospital for several weeks so your body can be supported while you recover.

You will also receive a number of CT scans, to make sure the brain abscess has been completely removed.

Most people will then need a further 6 to 12 weeks rest at home before they are fit enough to return to work or full-time education.

After treatment for a brain abscess, avoid any contact sport where there is a risk of injury to the skull, such as boxing, rugby or football.

Advice for drivers

If you've had brain surgery and you hold a driving licence, you are legally required to inform the Driving and Vehicle Licensing Agency (DVLA).

It's likely that the DVLA will suspend your driving licence due to your increased risk of having an epileptic fit. Your licence will only be returned once your GP or surgeon confirms that it's safe for you to drive.

For most people, this is likely to be 12 months after surgery with no seizures occurring.