Conclusion

The patient series listed in tables 1 and 5 were treated conventionally or by adjuvant HBO during similar time spans. As such, they are a fair basis for comparison.

Taking mortality as the criterion, and applying the one-sample test for binomial proportion (normal theory method), the results are significantly superior (p < 0.01) when HBO is applied as an adjunctive component to the otherwise standard therapeutic principles of ICA-management.

Based upon all these results, HBO has been approved by the Undersea and Hyperbaric Medical Society as well as by the ECHM in its last 2004 Consensus Conference for the treatment of intracranial abscesses under the following conditions:

• multiple abscesses, distributed all over one or both hemispheres,

• abscess in a deep or dominant location, where surgery would result in additional irreversible damage to neuronal structures of vital importance,

• immune compromised host (e.g. postoperative, post-traumatic or septic patients),

• situations where surgery is contraindicated or

• where the patient is of poor surgical risk,

• where there is no response or even deterioration in spite of standard surgical and antibiotic treatment procedures.

HBO as an adjunct therapy in ICA management is so effective that the next step should be a large multi-centre trial, comparable to a phase three study in pharmacology.

The full benefit of an HBO-based protocol is expected to become even more significant once additional study criteria, such as epileptic seizures and outcome measures such as the ability to return to work are properly documented in addition to the surveillance of the mortality rates.

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