The surgical management of brain abcess / by Alfred W. Adson and Winchell McK. Craig.

  • Adson, Alfred W. (Alfred Washington), 1887-1951.
Date:
1935?]
Catalogue details

Licence: In copyright

Credit: The surgical management of brain abcess / by Alfred W. Adson and Winchell McK. Craig. Source: Wellcome Collection.

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    REPRINTED FROM ANNALS OF SURGERY 227 South Sixth Street, Philadelphia, Penna. January, 1935 Copyright, 1935, by J. B. Lippincott Company. THE SURGICAL MANAGEMENT OF BRAIN ABSCESS By Alfred W. Adson, M.D., AND Winchell McK. Craig, M.D. of Rochester, Minn. FROM THE SECTION OF NEUROLOGIC SURGERY, THE MAYO CLINIC, ROCHESTER, MINNESOTA The management of brain abscesses still appears to be in a state of confusion. Many surgeons are in doubt when to drain an abscess and are uncertain concerning the procedures to use. We believe a review of our experiences at the clinic might therefore offer some assistance in the manage¬ ment of such abscesses. Cerebral abscess results from intracranial invasion of pyogenic organisms from acute or chronic infection of the middle ear, or frontal or accessory nasal sinuses, from compound penetrating injuries to the skull, and from infected emboli associated with such chronic suppurative lesions as osteo¬ myelitis and empyema or purulent bronchiectasis. A history of initial infec¬ tion with subsequent extension to the brain usually can be elicited. This is characterized by symptoms of meningitis or localized encephalitis, with or without an elevation of temperature, which in progressing produces signs of intracranial pressure. The three stages in the development of a cerebral abscess are (1) the initial stage of localized meningitis and encephalitis, with spontaneous recovery or progression to the second stage; (2) the quiescent stage, with encapsulation and liquefaction necrosis, and (3) the terminal stage, with recovery or death. Recovery may occur spontaneously with inspissation or resolution of pus, or it may occur following surgical drainage. Death ensues as a result of rupture of the abscess into the subarachnoid spaces and ventricle, or into adjacent brain tissue, with further extension of the lesion. The most expedient time for surgical treatment is during the second, or quiescent stage, and the success of the procedure depends on ade¬ quate and thorough drainage. The diagnosis and treatment of brain abscess has been gradual in evolu¬ tion, the earlier pathologists distinguishing between purulent and non-purulent encephalitis. Recognition of the etiological factors associated with abscess of the brain by Toynbee33 in England in 1855, and by Biermer in Germany in 1867, opened a new avenue of investigation. Clinical investigation was begun by Wernicke,35 whose pioneer work on aphasia augmented our knowl¬ edge of the diagnostic possibilities and the peculiar symptoms produced. Barker,7 Horsley,23 and Ballance6 were among the pioneers who attempted to deal with brain abscess by means of surgical interference. In a classical contribution, Macewen,29 in 1893, presented a summary of the essential features in diagnosis and treatment advocated at that time. Warrington,34 in discussing the etiological factors of brain abscess, divided the methods of 7 Printed in U. S. A.