HBOT AND INTRACRANIAL ABSCESS

Hyperbaric oxygen therapy is indicated as adjunctive therapy for intracranial
abscesses in deep and dominant locations or in cases of multiple abscesses.
Although most infections are anaerobic, aerobic infections also respond to HBO. It
may also be used in situations where surgery is contraindicated and in patients
showing no response to standard treatment. The development of perifocal edema
around an intracranial abscess may progress to secondary hypoxic lesions in the
surrounding brain tissues that can lead to a life-threatening situation and an increase
in intra-cranial pressure. The effects of hyperbaric oxygen therapy on perifocal brain
edema and the increased intra-cranial pressure has been well documented over 40
years ago in a series of studies performed by Miller et al. It was found that
hyperbaric oxygen caused a 30% reduction of intracranial pressure and a 19%
reduction of cerebral blood flow in the absence of changes in arterial PCO2 or blood
pressure, but only as long as administration of carbon dioxide caused an increase in
both intracranial pressure and cerebral blood flow. When carbon dioxide failed to
influence intracranial pressure or cerebral blood flow then hyperbaric oxygen had no
effect.
Lampl and Frey have reported on a number of cases treated with HBOT, with
excellent results, leading to the inclusion of this indication to the UHMS and
European list of indications. They also report in the dramatic reduction in mortality
with the use of hyperbaric oxygen (mortality reduced from 19.2% to 3.1%.
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