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.

    18/28 (page 662)
    Cerebellar Abscess.—A ventricular puncture should be made before an operation is performed for cerebellar abscess in order to lessen the intia- ventricular pressure, decrease the likelihood of jamming* the conus into the foramen after evacuation of the abscess, and allow one to control the intia- ventricular pressure during convalescence. This puncture is advisedly made over the anterior horn of the right side for the reason that it gives good access for subsequent tappings of the ventricle and places the site of puncture away from the likelihood of infection. In instances where a mastoid wound is not present, the approach to the abscess is made behind the lateral sinus. This allows clean exploration in case of negative findings. It also gives adequate exposure of the abscess if found. In the event that the lateral sinus has been opened for an infected thrombosis, or the abscess has perforated through the mastoid antrum or the lateral sinus, approach through the infected area would then be advisable. The procedure which I have described for cerebral abscess is advocated in the cases where the abscess is located centrally within the cerebellar lobe and is not fixed anteriorly to the petrus or dura. Such abscesses are more or less globular in shape and are in the minority. Most cerebellar abscesses are located on the anterior inferior surface of the cerebellum and project into the lobe. They are usually quite ovoid in shape and resemble an elongated bird’s egg. The smaller thickened pole of the capsule is attached to the dura or the petrus and is so fixed that no herniation can occur. In this type abscess the posterior pole of the wall or capsule of the abscess is exposed after the dura has been fixed to the cere¬ bellum by sutures and electrocoagulation and removal of the overlying cortex by suction. A portion of the capsule about the size of a dime is removed with the electrosurgical needle, the cavity is washed out and inspected and two small rubber drainage tubes (Dakin tube size with a lateral perforation near the distal end) are inserted into the cavity to the full extent. The ends of the two tubes will completely fill the pointed distal extremity of the abscess cavity, while the remaining portion of the capsule will collapse about the tubes. No secondary pocket will develop. The opposite is the case when drainage tubes are placed in a frontal or temporosphenoidal lobe abscess cavity for the reason that the smaller pole or portion of the cavity is directed toward the operator and the larger pole of the abscess is toward the ventricle. The cavity may not collapse equally about the drainage tube, and a secondary pocket is likely to develop. The incision in the scalp is closed at either extremity. The two tubes are brought out through the middle portion of the incision and about these the wound is loosely packed with iodoform gauze within the bony opening. The two tubes are fixed to the scalp to prevent displacement. In this type abscess there is no danger of perforation by the tubes. In subsequent dress¬ ings the tubes are irrigated with azochloramid solution, are allowed to remain in position for about three weeks, and then are gradually shortened until they are completely removed.