The abscesses in this case are life threatening and surgical evacuation is a must.

In retrospective analysis, at that time there was no MR Spectroscopy to be sure that this is surely an abscess before surgery. (24-April-2021).

The presence of such thick capsule, aspiration will not be satisfactory solution and the performed surgery is the proper one.

The patient was brought to Emergency of Shmaisani hospital semiconscious with right plegia and with no verbal communication. There was left otitis media with loss of hearing for several months with pus from the left ear.  MRI performed recently showing huge abscesses left cerebellar hemisphere and left occipital lobe with massive edema.

In setting position, wide left occipito-cerebellar osteoplastic craniotomy was done to expose the dura over the left occipital lobe and left cerebellar hemisphere. 2 separate incisions done above and below the left transverse sinus and the abscesses and their thick wall were removed. The occipital transcortical and the cerebellar was attacked subtentorially. The last had very thick capsule and it was necessary to remove it as a tumor with preservation of vital surrounding structures. It was possible at the end of surgery to see the brain stem and the running veins from the deep cerebral vein. Hemostasis. Routine closure

Smooth postoperative recovery. He was sent to the ICU for 24 hour observation.

The patient came to the clinic 25-August-2002 with clean wound and regression of the right plegia and can talk. The patient was advised to continue Targocid, Samixon and Epanutin.

histological result was brain abscess.

The last time he came to the clinic 27-October-2002 with MRI done 13-October-2002 showing small remnant of the abscess wall.