Robot-guided stereotactic single-stage evacuation of six intracranial abscesses: a rare case report with literature review.

Abstract

Background: Multifocal, deep-seated brain abscesses are uncommon and often lead to rapid neurological decline because of mass effects, widespread edema, and the challenge of safely accessing multiple intracranial compartments. Traditional surgical approaches may require staged operations or extensive craniotomy, increasing procedural risk. Robot-assisted stereotactic aspiration offers a minimally invasive and highly precise alternative, yet its application in single-session, multitarget drainage remains rarely reported. This case describes a young patient with extensive bilateral brain abscesses that were successfully treated through one-stage, robot-guided multisite aspiration, highlighting the potential advantages of this technique in complex infectious neurosurgical emergencies.

Case presentation: A 21-year-old woman presented with rapid onset of confusion, headache, and progressive neurological deficits. Magnetic resonance imaging revealed multiple deep abscesses involving the frontal, temporal, and occipital lobes, accompanied by severe cerebral edema and midline shift. After multidisciplinary evaluation, a single session of stereotactic aspiration was performed using a robot-assisted navigation system. Six abscess cavities were drained through four precisely planned trajectories during a single operation. Broad-spectrum antimicrobial therapy was initiated empirically and later tailored according to microbiological findings. A short-course of low-dose dexamethasone was added to reduce cerebral edema while minimizing the risk of impaired infection control. The patient demonstrated marked neurological improvement within several days and achieved full functional recovery within 1 month.

Conclusions: This case illustrates that robot-assisted, minimally invasive stereotactic aspiration may represent a potentially safe and effective strategy for managing multifocal deep brain abscesses in selected patients, allowing accurate multitarget drainage in a single procedure. The rapid recovery observed in this patient supports the clinical value of integrating precise surgical intervention with optimized antimicrobial therapy and controlled edema management. This approach may offer a viable treatment pathway for similarly complex intracranial infections where conventional surgery is associated with significant risk.