Robot-Guided Surgery Treats Multiple Deep Brain Abscesses in Single Session

Brain abscesses can progress rapidly and carry high morbidity, especially when multiple deep lesions cause mass effect and neurological decline. Conventional management often requires staged procedures or open craniotomy, increasing risk in unstable patients. Minimally invasive image-guided strategies are sought to decompress infection while limiting collateral injury. A new robot-guided stereotactic approach now offers single-session access to multiple deep abscesses with careful perioperative infection control.

In a case report published in the Chinese Neurosurgical Journal on May 27, 2026, clinicians at the First Hospital of China Medical University used robot-assisted stereotactic surgery to evacuate six intracranial abscesses in a single session in a 21-year-old woman. She had seven days of fever, headache, vomiting, and progressive decline in consciousness following treatment elsewhere for a suspected respiratory infection. MRI revealed six ring-enhancing abscesses in both frontal lobes and the right temporal and occipital lobes, the largest measuring 3.9 × 3.3 cm, with severe edema and a significant midline shift necessitating urgent intervention.

Instead of craniotomy, the team used a robot-assisted stereotactic navigation system. Preoperative MRI and intraoperative CT were fused to generate a three-dimensional brain model for trajectory planning, allowing clinicians to avoid critical vasculature, functional cortex, and the ventricles. Four safe trajectories were selected; two enabled “one puncture, two injections” to reach paired cavities, reducing the number of cortical entries. Each abscess was aspirated and irrigated with gentamicin-saline. Broad-spectrum antibiotics were started immediately and later narrowed after cultures identified Streptococcus intermedius and antimicrobial susceptibility results became available. Given the extensive edema, a short course of low-dose dexamethasone was administered with monitoring to limit immunosuppression.

Clinical and radiographic outcomes were favorable. Fever and meningeal signs improved within 72 hours, and consciousness recovered rapidly. At one month, magnetic resonance imaging showed complete resolution of the abscesses with near-complete disappearance of cavity walls. The patient achieved a Karnofsky Performance Status score of 100 and had no recurrence at six-month and one-year follow-up. The authors note that, in carefully selected patients, this minimally invasive, robot-guided approach—supported by multidisciplinary input from neurosurgery, neuroradiology, infectious diseases, and critical care—may reduce surgical trauma and enable rapid decompression, although larger studies are needed.

“This case highlights the advantages of precision minimally invasive multi-target surgery together with an evidence-based perioperative pharmacologic strategy,” said Jun Wang, Professor, Department of Neurosurgery, First Hospital of China Medical University.

“Robot-assisted stereotactic aspiration may represent a feasible and potentially effective strategy for managing multifocal deep-seated brain abscesses,” added Prof. Wang.