The treatment of cranial osteomyelitis and brain abcess / Alfred W. Adson.

  • Adson, Alfred W. (Alfred Washington), 1887-1951.
Date:
[1938?]
Catalogue details

Licence: In copyright

Credit: The treatment of cranial osteomyelitis and brain abcess / Alfred W. Adson. Source: Wellcome Collection.

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    THE TREATMENT OF CRANIAL OSTEOMYELITIS AND BRAIN ABSCESS Alfred W. Adson, M.D. SECTION ON NEUROLOGIC SURGERY, THE MAYO CLINIC Rochester, Minn. Suppurative lesions of the scalp, skull, accessory sinuses, meninges and brain bear an intimate relationship to one another since the infection may spread by contiguity or travel along lymph and diploic channels, and along emissary veins which communicate with veins that pass through the dura into the substance of the brain. Appropriate surgical treatment of the localized infection often will limit its extension and prevent the more serious involve¬ ment of the meninges and brain. The treatment of osteomyelitis of the skull does not differ from the treat¬ ment of osteomyelitis of other bones; removal of all necrotic and infected osseous tissue is required in addition to sequestrectomy. However, special consideration concerning these operative procedures is necessary, since the scalp and periosteum may have been destroyed, and removal of infected bony tissue may result in exposure of the meninges; moreover, brain abscesses are frequent sequelae of osteomyelitis of the skull. A consideration of the anatomic arrangement of the veins in the diploe and of the emissary veins is in order, so that it may better be understood how infections may travel through communicating veins to give rise to distant areas of osteomyelitis, with or without accompanying brain abscess. Infective em¬ boli in the arterial system are rarely responsible for osteomyelitis of the skull. Thrombosis of vessels in an extending infection of the scalp frequently spreads the osteomyelitis. The arterial supply to soft tissues and haversian canals about an osteomyelitic region serves as a barrier to limit the progress of infection by maintaining the life of the osseous tissue. Frequently, the osteomyelitic process will destroy but one table of the skull when the circula¬ tion to the opposite table has been maintained. Gray22 states: “The diploic spaces of the cranial bones in the adult contain a number of tortuous canals, the diploic canals (canales diploid [Brescheti ]), which are surrounded by a more or less complete layer of osseous tissue. The veins they contain are large and capacious, their walls being thin and formed only of endothelium resting on a layer of elastic tissue; they present at irregular intervals pouch-like dilatations, or culs-de-sac, which serve as reservoirs for the blood. “In adult life, so long as the cranial bones are distinct and separable, these veins are confined to the particular bones; but in old age, when the sutures are united, they communicate with one another and increase in size. They communicate, in the interior of the cranium, with the veins and sinuses of the dura, and on the exterior of the skull with the veins of the pericranium. They