Background <p>The aim of this study was to investigate the clinical presentation, imaging features, and outcome of patients diagnosed with brain abscess and treated by stereotactic aspiration.</p> Methods <p>We retrospectively analyzed the medical data of all consecutive patients diagnosed with brain abscess who underwent stereotactic aspiration in our department from 2015 to 2022. The demographic characteristics, clinical presentation, radiological data, microbial aetiology, and outcome were collected and analyzed using t-test or χ² tests.</p> Results <p>Overall, 120 patients were identified. The mean age was 49.7 years (range: 5–81); 59.2% were male. Seventy-nine patients (65.8%) had comorbidities, of which cardiovascular diseases was the most common. Most of the abscesses were solitary frontal or temporal lesions. A microbiological diagnosis was secured in 70 (58.3%) of cases, among which the majority were of the <i>Streptococcus</i> spp. Outcome was favorable in 107 (89.2%) of cases. The mortality rate during the initial hospital stay was 2.5%. A total of 10 individuals (8.3%) presented with preoperative delirium or coma, which was associated with an inferior clinical outcome compared to those who exhibited clear consciousness. (<i>p</i> = 0.01).</p> Conclusions <p>Stereotactic aspiration was a safe intervention with a low incidence of complications. The combination of stereotactic aspiration and antibiotic therapy was an effective treatment strategy for brain abscess. Patients who underwent stereotactic aspiration while in a state of disturbance of consciousness demonstrated a poorer outcome compared to those who were conscious.</p> Clinical trial number <p>Not applicable.</p>