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How Hyperbaric Oxygen Therapy (HBOT) Works in the Treatment of Intracranial Abscesses (ICA)


Intracranial abscesses (ICA) comprise cerebral abscess, subdural empyema, and epidural empyema. The three disorders have numerous similarities and effects on the head and human body. The most affected parts of the skull cavity are the paranasal sinuses, mastoid cells, and the middle ear. The condition has a high mortality and morbidity rate; the former ranges between 10-40% while the latter ranges between 15-60%. The condition manifests itself in the form of accumulated pus encased within the brain parenchyma once the bacterial/viral infection finds its way to the head.

Some of the causative microorganisms of the disorders include bacteria, mycobacteria, protozoa, fungi, or helminths. The disorders that make one most vulnerable to intracranial abscesses include sinusitis, otitis, mastoiditis, dental infection; hematogenous seeding, and cranial trauma. The relatively rare condition is fatal especially if it is not treated early. Mortality is also high in instances where multiple abscesses occur. However, it is especially high in patients suffering from human immunodeficiency virus (HIV) infection or acquired immune deficiency syndrome (AIDS). This is because of the highly compromised immune system.

Mechanism of Action

HBOT addresses the bacteriological tendencies associated with ICA by improving the antimicrobial properties of the body. This is attributed to the high partial pressure in the oxygen chambers which suppresses the anaerobic flora that would normally thrive in the ICA. Immunity is boosted therefore the body and brain can defend themselves against any microbial attacks. Most of the pathogens that lead to the abscesses thrive in an environment with minimal oxygen supply therefore hyperbaric oxygen (HBO) counters their actions through hyper-oxygenation of the perfused tissues. They are limited from further spread, and infection and they are eventually killed. HBO leads to the disintegration of various cell barriers that favor pathogen action as well as a reduction in inflammation. The tissue surrounding the affected regions of the cranium is able to regenerate as well.

The consistent brain tissue oxygenation associated with HBOT also leads to a decline in edema and perifocal brain swelling as a result of the accumulated pus. The reactive oxygen species synthesized in this form of treatment triggers neutrophils to act on the pathogens: both aerobic and facultative anaerobic bacteria. The heightened oxygen pressure also counters the intracranial pressure as a result of the condition. The suppression results in vasoconstriction which has the effect of cancelling the severity of the condition. The soft tissues in the cranial cavity can resume normal functioning. HBOT has a high success rate when coupled up with other modes of treatment which the intracranial abscesses are slowly growing resistant to. It increases the efficiency of antibiotics by increasing its penetration and absorption. It is well tolerated by the body since it is non-invasive and safe.

References

Bártek, J., Jakola, A. S., Skyrman, S., Förander, P., Alpkvist, P., Schechtmann, G., Glimåker, M., Larsson, A., Lind, F., & Mathiesen, T. (2016). Hyperbaric oxygen therapy in spontaneous brain abscess patients: a population-based comparative cohort study. Acta Neurochirurgica, 158(7), 1259–1267. https://doi.org/10.1007/s00701-016-2809-1

Tomoye, E. O., & Moon, R. E. (2021). Hyperbaric oxygen for intracranial abscess. Undersea & Hyperbaric Medicine, 48(1), 97–102. https://doi.org/10.22462/01.03.2021.12


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