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.

    6/28 (page 650)
    May, 1936 JOSEPH E. J. KING porary eversion and herniation. This method was advocated following the recovery of a patient in 1920 and of two other patients in 1923 who were operated upon in this manner. Previous to this time drainage tubes had not proven satisfactory for one reason or another, and in the method described they were completely discarded. The principles set forth at that time aie still adhered to in general, with some modifications which will be dealt with later in this paper. I11 1925, Cahill4 reported a series of cases treated by the use of the Mosher drain which was first considered by Mosher in 1915. The abscess was oper¬ ated upon in two stages and was entered, in the majority of cases, by the mastoid route. Subsequently, in papers presented in 1929 and 1933, CahilM c advocated a more extensive removal of the brain cortex and capsule of the abscess, so that the drain could be more accurately placed into the abscess cavity. He stated that “the formation of a fistulous tract about the drain to the abscess cavity in part makes the capsule extend to the surface of the brain,” which approaches in some degree the method described by the author. In a personal communication, Cahill7 described the formation of a small hernia or “nubbin” at the site from which the drain was finally removed in the cases operated on according to his modified method. It is believed that this small hernia represents the remnants of the contracted abscess cavity which has found its way to the surface. Cahill described the use of the Mosher drain in cases of otitic abscess and advocated its use in cases treated by the otologic surgeon. Horrax,18 in 1934, described a procedure first advocated by Dr. Cushing 10 or 12 years earlier for certain chronic encapsulated brain abscesses. He termed it “marsupialization.” It decidedly belongs to the open method. Horrax made an opening in the skull about the size of a half dollar, a similar opening in the dura, removed the overlying cortex, removed a portion of the presenting abscess wall after partial evacuation of the abscess, fixed the cut edges of the capsule to the galea with sutures, and filled the abscess cavity with gauze lightly packed over a thin layer of gutta percha. Over this pack¬ ing of gauze another layer of perforated gutta percha was placed and the entire area was covered with dry dressing and bandage. Subsequently the gauze and gutta percha were gradually extruded by herniation of the abscess cavity outward and were finally removed. A hernia cerebri may have devel¬ oped, but this subsided. The area became covered with granulation and epi- thelialized. In this procedure thorough removal of the contents of the abscess cavity and inspection of the cavity can be accomplished. With the exception of suturing the edges of the capsule to the galea, this procedure, in general principles, is quite similar to the one proposed by the author. Horrax reports only one death in a series of eight cases operated upon by him according to the marsupialization method. Sachs reported a successful case operated upon by this method. In 1932, the author20 operated upon a case of temporosphenoidal abscess which had spontaneously ruptured through the mastoid wound. The capsule