Cerebellar abscesses of otitic origin in nine children : eight recoveries after cannulation / Frederic Schreiber.

  • Schreiber, Frederic.
Date:
[1941], ©1941
Catalogue details

Licence: In copyright

Credit: Cerebellar abscesses of otitic origin in nine children : eight recoveries after cannulation / Frederic Schreiber. Source: Wellcome Collection.

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    REPRINTED FROM ANNALS OF SURGERY 227 South Sixth Street, Philadelphia, Penna. Vol. 114 SEPTEMBER, 1941 No. 3 Copyright, 1941 , by J . B. Lippincott Company. CEREBELLAR ABSCESSES OF OTITIC ORIGIN IN NINE CHILDREN EIGHT RECOVERIES AFTER CANNULATION Frederic Schreiber, M.D. Detroit, Mich. FROM THE DEPARTMENT OF SURGERY, WAYNE UNIVERSITY COLDEGE OF MEDICINE, DETROIT, MICH. Cerebellar abscesses in nine children have been treated surgically by the author during the past seven years. In each instance the symptoms of abscess became manifest after mastoiditis and mastoidectomy. Operative treatment was the same for all cases, and was delayed as long as possible without jeopardizing life from increased intracranial pressure, to allow the abscess wall to thicken and the acute symptoms of meningitis and cerebritis to subside. Slowing of pulse or respiration with increasing restlessness and stupor were the warning signs that surgical interference was imperative. No lumbar punctures were made, for fear of medullary herniation. Medication was avoided, especially with barbiturates or narcotic drugs which would pro¬ duce added anoxic insult. Under local anesthesia, a one-half inch trephine opening was made over the suspected cerebellar lobe with a Hudson bur, midway along a line between the occipital protuberance and the mastoid tip (Fig. 1). The dura was incised one-fourth inch to allow insertion of a blunt cannula with a side open¬ ing. The cannula was inserted into the abscess allowing its contents to escape. Usually, the first pus was thin and watery and the last thick and stringy. The abscess cavity was never washed out; the wound was always closed tight with silk. Brief abstracts of each of the nine cases of cerebellar abscess in children are appended; certain details of the cases illustrate pertinent considerations in successful diagnosis, preoperative, surgical, and postoperative treatment of this condition. ABBREVIATED CASE REPORTS Case 1.—Judith S., age four, was admitted to hospital with painful swelling behind left ear; swelling had been discharging for two months. Child had been nervous, weak and without appetite since tonsillectomy a year before. Mastoidectomy was performed day following admission—a large quantity of pus was found and a small dural exposure was made. Extreme hyperemia of all structures made operation difficult but recovery was fairly uneventful until one month later, when child refused food, vomited, and tem¬ perature remained at ioi° F. for a week. Spinal fluid showed 1,575 polymorphonuclear cells, with cocci in chains. Numerous spinal taps were made during the following month. Cultures were negative. When first seen by the author, nine weeks after mastoidectomy, the child was listless, vomiting, and showed marked ataxia of the left arm. Optic disks were rosy. Seven days later the child became comatose, there was early papilledema and considerable ataxia of left arm and leg. At operation, resistance of abscess wall was felt at depth of 3 cm., and penetration with the cannula allowed green pus to extrude. Culture: Streptococcus haemolyticus. One ounce escaped before the child became livelier and the needle was 330 PRINTED IN U.S.A.