Brain abcess / Joseph E.J. King.

  • King, Joseph E. J.
Date:
[1936?]
Catalogue details

Licence: In copyright

Credit: Brain abcess / Joseph E.J. King. Source: Wellcome Collection.

    16/28 (page 660)
    May, 1936 JOSEPH E. J. KING Frontal Lobe Abscess.—In the vast majority of cases abscesses of the frontal lobe follow infections of the nasal cavity and the accessory sinuses, with or without osteomyelitis of the frontal bone. They aie usually ovoid in shape with the smaller end directed forward when the source of infection is the ethmoids or the frontal sinus. Most of them have but a small area of brain substance intervening between the anterior portion of the abscess wall and the inner table of the skull (posterior wall of the fiontal sinus 01 ethmoids), and some may have perforated and drained into the nasal cavity. Those which develop secondary to osteomyelitis of the frontal hone are more likely to be spheroid. Eradication of the extracranial source of infection should be accomplished in all cases where the general condition of the patient will permit. Provided a definite diagnosis and localization of a frontal lobe abscess has been made, operation upon the frontal sinus and ethmoids, if necessary, should be done by the rhinologic surgeon and followed immedi¬ ately by operation upon the abscess. If osteomyelitis of the frontal bone coexists, the complete operation for this condition according to a modified Furstenberg16 procedure should be carried out. After removal of the in¬ volved frontal bone, an extradural pus pocket may be found. An opening through the dura leading into a subdural or subcortical abscess may be seen. If so, the abscess should be opened immediately. Otherwise, opening of an intact dura is better deferred unless one is certain that a subcortical abscess is present. The incision begins in the outer extremity of the eyebrow, extends in¬ ward through the eyebrow to its inner extremity obliquely upward and inward to the midline of the forehead at the root of the nose, from which point it is carried vertically in the midline to within the hairline and thence downward for about two or two and one-half inches toward the temporal region. The flap consisting of all soft parts, except the pericranium, is turned down. The pericranium is included in the flap in cases of osteomyelitis of the frontal bone. This incision allows one to clean out the frontal sinus with preser¬ vation of the supra-orbital ridge, and to evacuate the frontal lobe abscess. Should it be necessary to exenterate the ethmoids, a short curved incision extending from the inner inferior angle of the incision is carried downward over the ethmoid region. The free end of the flap is turned underneath, thus folding the flap on itself, and is sutured loosely with the denuded surfaces approximated. This keeps the flap out of the way, controls bleeding from it, and prevents it from shriveling, as otherwise it would do if left free. After the floor of the abscess has herniated to the surface of the skull, it is maintained at this level by lumbar punctures, should they be necessary. When the surface has become firm and well granulated or covered with epithelium, the flap is unrolled and replaced in position. After healing, the only portion of the scar which can be seen is that in the midline. This is scarcely notice¬ able and may be altogether lost in the vertical wrinkles of the forehead. The other portions of the scar are within the eyebrow and the hairline and are not seen.