This was a retrospective study of patients diagnosed with intracranial suppurations at the neurosurgery department of Donka National Hospital in Guinea between January 1^st, 2019, and October 31^st, 2025.

The study included 201 patients who met the following criteria: had complete medical records, were diagnosed with intracranial suppurations based on clinical presentation, imaging studies, and laboratory tests, and were managed at the neurosurgery department of Donka National Hospital in Guinea.

Inclusion criteria: Patients of all ages and sexes. with a confirmed diagnosis of intracranial suppurations. Exclusion criteria: patients with incomplete medical records and who did not undergo imaging studies or laboratory tests.

For each patient, a pre-established patient information sheet was created, and the medical record review allowed us to collect the following parameters: age, sex, place of origin, medical history, clinical presentation, and admission timing (from onset of symptoms to consultation). Imaging studies, such as CT scan or MRI, were performed to confirm the diagnosis and assess the extent of the infection. type of collection, the location, and the size of the collection were identified. The imaging studies were reviewed by experienced radiologists. Laboratory tests, such as blood culture and CSF (cerebrospinal Fluid) analysis, were performed to identify the causative organism and assess the severity of the infection. Microbiological analysis was performed on CSF (cerebrospinal Fluid) and/or pus samples. The samples were cultured for aerobic bacteria, and fungal cultures were also performed. Typically involved antibiotics and surgical drainage. Antibiotics were administered empirically based on the suspected causative organism and then adjusted based on culture and the sensitivity results. Surgical drainage was performed in patients with the large volume abscesses or those who did not respond to medical treatment. The surgical procedures included drainage of the abscess, excision of the capsule, and debridement of necrotic tissue. Outcome Measures were estimated with Glascow Outcome Scale (GOS):

favorable outcomes (GOS 1-2): Good recovery (GOS 1): the patient has returned to their pre-illness level of functioning, with minimal or no neurological deficits.Moderate disability (GOS 2): the patient has some neurological deficits but can perform most daily activities independently.Unfavorable outcomes (GOS 3-5): severe disability (GOS 3): the patient is dependent on others for daily activities, but is conscious and able to communicate.vegetative state (GOS 4): the patient is unconscious and unable to communicate or respond to their environment. Death (GOS 5): the patient has died because of the intracranial suppuration.

Descriptive statistics were used to summary the data. Categorical variables were presented as frequencies and percentages, while continuous variables were presented as means and ranges. To determine the predictors of mortality, we performed a multivariate logistic regression analysis on the data collected from patients with intracranial suppurations. The analysis included variables such as age, Glasgow Coma Scale (GCS) score, presence of multiple abscesses, delayed treatment, and other relevant clinical and laboratory parameters. Statistical analysis was performed using SPSS software.

The study was approved by the institutional review board of Donka Nation Hospital. Informed consent was not required due to the retrospective nature of the study. The data were collected and analyzed by experienced researchers.

The study had some limitations, including its retrospective design and the potential for selection bias. Additionally, the study was conducted at a single center, which may limit the generalizability of these findings.

The neuroimaging studies, such as cranial CT scan in 89.05% cases and brain MRI, were performed for diagnosis in 22 cases (10.95%). The imaging characteristics of types of intracranial suppurations are shown in Figure 2.

The most common locations of intracranial suppurations were frontal (30.35%), parietal lobe (19.40%), temporal lobe (34.83%), and cerebellum (15.42%). Brain abscess was the most common type of intracranial suppuration across all age groups (Figure 2).

Mean was 87.23 ± 28.34 hours. The time to surgery within 24 hours was achieved in 18% of cases, which is crucial in improving outcomes for patients with intracranial suppuration, and delayed response (>72 hours) occurred in 57% of cases (Table 2).

Figure 2. A bar chart showing the proportion of different types of intracranial suppurations in the study population.

Table 2. Comparison of surgical interventions, surgical techniques used, and time to surgery.

Otitis was the most common cause found in 75/201 (37.31%) of cases, against the sinusitis, which was found in 34.33% of cases, and the streptococcus pneumonia was the most common microorganism identified in both children and adults (Table 3).

Treatment included the antibiotics it was the broad-spectrum antibiotics to treat the underlying infection for all cases (100%), Surgical drainage or excision of the abscess in 121 cases (60.20%) cases with large abscesses; significant mass effect, all patients have the supportive care: management of increased intracranial pressure with corticosteroids in 81 cases (40.30%) and seizures with anticonvulsants in 79 cases (39.30%) and others complications in 12 cases (5.97%) (Figure 3).

Table 3. Laboratory blood test, microbiology of patients.

Figure 3. Antibiotic sensitivity testing of patients.

Globally, the outcome was favorable in 71.14% of cases (Table 4 and Figure 4), with a mortality rate of 10.95%.

Figure 4. Outcome of patients with intracranial suppurations.

Table 4. Comparison of treatment outcomes.

We also found that age > 60 years, Glasgow Coma Scale < 8, and multiple abscesses were predictors of mortality (Table 5).

Table 5. Predictors of mortality.

Figure 5. CT scan shows cerebellum abscess (A and B) and multiple empyema frontal and interhemispheric location (C).

Figure 6. CT scan with contrast (A and B) axial slide and (C and D) coronal slide shows the midline frontal empyema.

The images illustrate the topographic locations and intraoperative findings of intracranial suppurations in our series. The cerebellum abscess represented 15.42% in our series (Figure 5(A) andFigure 5(B)) and frontal suppuration location was 30.35% in cases (Figure 6 and Figure 7). We found the temporal lobe location in 34.83% (Figure 8 and Figure 9).

Figure 7. Intraoperative image showing the middle line approach for frontal empyema.

Figure 8. CT scans with contrast show the left temporal abscess.

Figure 9. Intraoperative image showing (A) the right craniotomy temporal abscess resection and (B) showing the surgical specimen, the abscess wall, for histopathological examination.