THE TREATMENT OF BRAIN ABSCESS.

Abstract

THIS review of a personal experience of the management of cases of brain abscess during the last five years is based upon 31 cases. Although 17 died, there has been a steady improvement in results, due in part to an increasing experience, and to a more mature judgment, for in no other branch of neurosurgery is an unremitting personal attention to details more essential for success. Much of the improvement, however, is due to a complete change in the fundamental method of treatment, namely, from drainage to the closed method of Clovis Vincent. In 1936 there were two cases: the abscess was drained in each, and both died. In 1927 all of four cases were treated by drainage and only one lived. There were seven cases in 1938: in four, the abscess was drained and three of these died; in the other three the abscess was aspirated and in one of these a decompression was also performed-all of these three cases recovered. During that year I was impressed by the value of aspiration and I decided to employ it more frequently. Drainage was practically abandoned, for during the remaining period under review it was used in only two cases; one of these died, and in the other aspiration and a subtemporal decompression preceded drainage and the patient recovered. In 1939 there were nine cases, treated by various closed methods and by drainage in one case, and four lived. Four out of five cases recovered in 1940, and in 1941 two of four cases have lived. In the following analysis are set out the various procedures and their results: