The treatment of brain abcess / Paul C. Bucy.

  • Bucy, Paul C. (Paul Clancy), 1904-1992.
Date:
[1938?]
Catalogue details

Licence: In copyright

Credit: The treatment of brain abcess / Paul C. Bucy. Source: Wellcome Collection.

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    CARCINOMATOUS METASTASES TO THE BRAIN i i William J. German, M.D. New Haven, Conn. FROM THE DEPARTMENT OF SURGERY, YALE UNIVERSITY SCHOOL OF MEDICINE, NEW HAVEN, CONN. j The treatment of carcinomatous metastases to the brain is a subject ! which is unlikely to arouse much general interest because of the hopeless outlook from a curative standpoint. However, on the same basis, the ultimate I prognosis is almost equally discouraging in infiltrative gliomata (glioblastoma S multiforme). In fact, all types of palliative surgery for malignancy fall into this category, in which an eventual mortality is inevitable. With the realization that curative therapy is impossible, it becomes nec¬ essary to seek other criteria upon which to base the advisability or inadvis¬ ability of surgical intervention. Obviously, the simplicity or multiplicity of the intracranial lesion is of primary importance. The present report is based entirely upon cases in which the metastasis appeared to be solitary. As in other forms of palliative surgery, three other factors must be considered: (i) The relief of symptoms; (2) duration of life; and (3) the operative mortality. The present cases are analyzed in regard to these three factors. Grant'^ in 1926, compared the results in 25 cases, in whom some form of intracranial operation was performed, with those in 22 cases who were not operated upon. He stated: ‘‘The average length of life from time of admission to this hospital to death in both verified and unverified cases, whether operated or non-operated, whether radical extirpation or palliative decompression was performed, was less than four months.” There is no doubt that these dis¬ couraging results have strongly tempered the opinion of the profession re¬ garding surgical intervention in cases of malignant intracranial metastases. However, one conclusion of Grant’s is often overlooked. After stating that surgery is unable to prolong the life of these patients, he added: “But surgical intervention for the relief of intracranial pressure is frequently indicated and may go far toward relieving suffering in the last few months of life.” Shelden,^ in 1926, reviewed 40 cases of secondary tumors of the brain, from the aspect of diagnosis. Although his paper was not primarily con¬ cerned with surgical indications, he distinctly intimated that surgical inter¬ vention was not advisable. This passive attitude toward the problem was challenged by Oldberg,^ in 1933. He reported three cases of metastatic cere¬ bral lesions with survival periods of eight months, two years and three years. As further evidence in support of operative intervention, he cited a case of | a cervical cord meningioma, wrongly diagnosed as metastatic carcinoma be¬ cause of previous malignancy. Fortunately, the patient was operated upon and the benign tumor removed. This is a striking example of the fact that Submitted for publication March 24, 1938.