Primary intraventricular brain abscess: a systematic review of risk factors, etiology, and management

Abstract Objective Primary intraventricular brain abscesses (PIAs) are rare, with no established treatment guidelines. Despite advancements in imaging, neurosurgical techniques, and antimicrobial therapies, PIAs remain challenging. This systematic review aims to synthesize literature on PIAs to inform clinical decision-making. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Google Scholar, Embase, and SCOPUS databases were searched to examine PIA. Results 13 PIA cases were identified, with a mean age of 34.5 ± 25.3 years (range: 10–80, median: 23), and a slight male predominance (7/13). Predisposing factors were present in 61.5% (8/13) of cases, including chronic otitis media (15.4%, 2/13) and immunocompromised (7.7%, 1/13). Fever (69.2%, 9/13) and headache (53.8%, 7/13) were the most common symptoms. Hydrocephalus was present in 61.5% (8/13) of cases, with six patients (41.2%) requiring ventriculoperitoneal (VP) shunting. Abscesses were located mostly in the lateral ventricles (left 38.5%, right 30.1%, bilateral 23.1%). Streptococcus species were identified in 23.1% of cases, Staphylococcus species in 15.4%, gram-negative bacteria (including Escherichia coli and Klebsiella oxytoca) in 30.8%, and Mycobacterium tuberculosis, Cladophialophora bantiana, or acid-fast bacilli in 7.7% of cases each. Surgical management included craniotomy or craniectomy with excision (38.5%), stereotactic aspiration (23.1%), and external ventricular drain (EVD) (23.1%). All patients received antibiotics guided by the species identified. Mortality occurred in 15.4% of cases, while 84.6% had resolution or were discharged with varying degrees of recovery. Conclusion PIAs are rare and require surgical intervention and targeted antimicrobial therapy for optimal outcomes.