The cases of nine pacients with intracranial abscess operated on by aspiration are reported. Only one patient did not survive. One pacient developed postoperative seizures and, another, hemiparesis. In 5 cases it was necessary a relief of increased intracranial pressure by neurosurgical emergency.

/pdf/treatment-of-intracraneal-abscess-by-tapping-oxkgez3zkv.pdf

Treatment of intracraneal abscess by tapping

Two hundred cases of intracranial supratentorial abscess have been reviewed: 100 spanned the years 1951 to 1957, and 100 the years 1962 to 1967. The mortality rate of 40% was the same in both series, chiefly owing to continuing inaccurate localization of the abscess and inadequate use of antibiotics. The hazards of lumbar puncture are real, and this procedure is contra-indicated when convulsions, signs of a hemisphere disturbance, or papilloedema are present. Of the methods for localizing intracranial abscess the site of E.N.T. sepsis, ventriculography, and brain scanning were found to be the most valuable. Penicillin in high dosage continues to be the most important antibiotic. The results of assiduously repeated burrhole aspiration compare favourably with those of later excision.

https://www.bmj.com/content/bmj/2/5648/7.full.pdf

Management of Supratentorial Intracranial Abscess: A Review of 200 Cases

✓ Eighty-six patients with brain abscesses were seen at the University of Minnesota Hospitals from 1946–1965, and 46 died, a 53% mortality. Multiple and brain stem abscesses accounted for several fatalities, while delayed and missed diagnosis accounted for one third of the deaths. Evidence of infection was often minimal in patients with brain abscess. Lumbar puncture as a diagnostic tool was inaccurate and occasionally fatal. Brain scan, electroencephalography, and angiography were the best diagnostic tests. Drainage and excision were each associated with approximately a 20% mortality. The most pertinent correlation regarding treatment, however, was that of increasing mortality with deteriorating preoperative neurological status. Postoperative deaths were due to failure in locating the abscess at surgery or untoward events such as cerebritis, edema, or excessive bleeding at the operative site.

Experience with brain abscesses

In treating brain abscess we have three primary concerns: saving life, preserving or restoring function, and preventing sequels such as epilepsy and recurrence of infection. Our success with the first of these is accurately expressed by the immediate mortality rate, but information about the last two can only be obtained by long-term follow-up studies. And for statistical assessment larger figures are required than any one clinic can supply. Furthermore, the methods of treatment tend to differ in different clinics. In Oxford, for instance, we have records of about 120 cases of brain abscess treated since 1938, but most of these have been dealt with by excision after successful aspiration, and we have little useful information about aspiration or other forms of drainage as the sole procedure. Accordingly we approached Professors Norman Dott and Sir Geoffrey Jefferson who kindly placed at our disposal the records of their cases treated in Edinburgh and Manchester over the last 25 years or so. From the three centres there were altogether 295 cases. Of these patients, 118 died soon after operation (40%). The remaining 177 patients survived for periods up to 26 years, and of these it has been possible to obtain adequate follow-up information in 173 cases. As we were particularly interested in the long-term results, we have not included any cases treated within the last 12 months. We found that in general three methods of treatment had been used (Table I): aspiration (with or without a decompression); continuous drainage by a tube, or by marsupializing the abscess; and excision (with or without previous aspiration and/or decompression). No clinic had applied any of these methods to the exclusion of others, but there was a strong preference for excision in one clinic, and for continuous drainage in another. In the third clinic there was less rigidity and the various methods all had a fair trial.

https://jnnp.bmj.com/content/jnnp/14/4/308.full.pdf

Brain abscess: aspiration, drainage, or excision?

In 1948, Schiller, Cairns, and Russell presented 33 cases of subdural empyema arising over 20 years most of which were treated in this department. Their paper dealt with the results of penicillin instillations into the subdural space and marked a major therapeutic advance in the treatment of this condition. We felt it would be of interest to review 29 subsequent cases and to note the present-day problems in their management. The history of the recognition of this condition has been outlined in detail by Kubik and Adams (1943) and by Courville (1944), and there is little to add to their accounts. Schiller et al. (1948) used the term 'purulent pachy meningitis interna' because of a supposed resemblance to peritonitis. 'Subdural abscess' is often used, but should only be applied when there is loculation and a membrane is formed. Subdural empyema is a better term, indicating pus in a pre-formed space.

https://jnnp.bmj.com/content/jnnp/27/5/422.full.pdf

Subdural empyema: a review of 29 cases.

I N MOST instances the bacteria responsible for brain abscesses are sensitive to penicillin. For this reason a considerable improvement in the prognosis of these lesions is to be assumed. In this, our experience undoubtedly agrees with that of the majority of neurosurgeons. There is, however, a tendency toward the belief that the use of penicillin may either simplify the surgical treatment of brain abscesses or actually do away with such treatment. On the contrary, we believe that, thanks to penicillin, more radical operations can be undertaken successfully for abscesses which otherwise could not have been cured. The method that we advocate, and that we have used in the treatment of every brain abscess encountered during the past fifteen months, may be summed up thus: Complete extirpation of the abscess, no matter what its form, whether acute or chronic, single or multiple, even though this may mean opening up a communication between the abscess and the ventricle. We have operated upon 17 brain abscesses in this way. In the first 3 cases, when penicillin was not available and when complete extirpation could not be carried out, the patients did not survive. In the following 14 cases (13 with penicillin and 1 without) the patients were all completely and rapidly cured. I t should be added that 10 of these 14 cases showed a serious form of abscess, including 3 which were metastatic from the lungs. We came to adopt the complete extirpation in one stage by utilizing in general the method described by Clovis Vincent, 8 with the addition of penicillin. Vincent's method of dealing with both acute and chronic abscesses may be summarized as follows: 1. Acute abscesses. In order to lower the threatening increased intracranial pressure, the abscess is first tapped. A bone flap is then turned down in front of the abscess without opening the dura. This usually suffices to lower pressure sufficiently so that further procedures may be postponed until the abscess has formed a capsule. ~. Chronic abscesses. This means, as a rule, well encapsulated abscesses. They should be extirpated "en masse," without opening the capsule and without drainage. While the complete extirpation method proved to be a great improvement in many instances, it was still inadequate in dealing with certain types of abscess, as Vincent pointed out himself2 These types were:

Treatment of intracraneal abscess by tapping

References

Management of Supratentorial Intracranial Abscess: A Review of 200 Cases

Experience with brain abscesses

Brain abscess: aspiration, drainage, or excision?

Subdural empyema: a review of 29 cases.

Radical surgery and penicillin in brain abscess; a method of treatment in one stage with special reference to the cure of three thoracogenic cases.