intracranial tuberculosis abscess resection

In recent years, the incidence of cerebral tuberculoma at home and abroad has gradually declined. In developed countries, cerebral tuberculosis accounts for about 0.2% of intracranial lesions, and in developing countries 5% to 8%, in several large cities in China. Statistics accounted for 1% to 2.5% of intracranial tumors in the same period. Cerebral tuberculoma is more common in adolescents and children under the age of 30, and there is no significant difference in the incidence of men and women. Cerebral tuberculoma is often caused by hematogenous dissemination, and can be single or multiple, more common in single-shot. The size of the lesion, according to Liu Qingliang et al (1996) reported in 25 cases: 4 cases of diameter less than 1cm, 15 cases of 2 ~ 3cm, 6 cases of more than 3cm. About 1/3 of patients have primary TB lesions in other areas. Brain tuberculoma can occur anywhere in the brain, but the incidence on the screen is higher than the screen. The cerebellar hemisphere, frontal lobe, parietal lobe, and temporal lobe are more common, and brain stem tuberculosis is also seen, accounting for about 5% of brain tuberculoma. Clinical brain tuberculoma can be divided into two types: 1 systemic type, with other organs active tuberculosis, brain tuberculosis often occur. 2 brain tumor type, there is no active tuberculosis of other organs, brain tuberculosis often single, the surgical effect is better. Its clinical manifestations are mainly symptoms of increased intracranial pressure; systemic symptoms include fever, weight loss, malnutrition, and increased erythrocyte sedimentation rate. Most of the on-screen lesions are characterized by epileptic seizures. The underlying agents are most common with cerebellar ataxia. The brain stem tumors often first have cranial nerve dysfunction. CT and MRI are important means of diagnosing brain tuberculosis. CT plain cerebral tuberculomas can be nodular, high-density or mixed-density nodules (single or multiple), with mild cerebral edema and low-density shadows, and have a mass effect, long-term patient nodules High density calcification can be seen. After the enhancement, the scanning lesions were mostly ring-shaped. When there was caseous necrosis, the center showed a low density: when the contents were calcified, the center showed a higher density. The "target symptom" is a typical manifestation of brain tuberculosis. MRI's T1 weighted image appears as a low signal, and most of the signals on the T2-weighted image are uneven, showing a low, equal or slightly higher signal; the T1 weight of the envelope is equal or slightly higher, and the T2 weighting is low. MRI showed that brain tuberculosis lesions were clearer than CT, especially after enhancement. In recent years, due to the improvement of diagnostic techniques and the application of anti-tuberculosis drugs that easily pass the blood-brain barrier, scholars believe that for tuberculosis, the first anti-tuberculosis drugs should be treated for 8 weeks, only in the diagnosis or medical treatment. A biopsy is considered to determine a diagnosis or surgical resection when there is no response. Treatment of diseases: brain tuberculosis Indication 1. Patients with regular anti-tuberculosis treatment for 8 to 12 weeks have no obvious improvement or gradually increased lesions. 2. The lesion is large, with obvious occupying effect, causing increased intracranial pressure and endangering the patient's life. 3. Multiple lesions can remove large lesions associated with intracranial hypertension. Contraindications 1. Anti-tuberculosis treatment should be preferred if there is no life-threatening patient and the clinical diagnosis is clear. 2. Multiple brain lesions, combined with other organs active tuberculosis, can not tolerate the operator. Preoperative preparation When the condition allows, preoperative anti-tuberculosis drugs should be treated for 2 weeks to reduce the possibility of postoperative tuberculous meningitis. Surgical procedure 1. According to the lesion, design the scalp incision and bone or bone window craniotomy. 2. The lesion was revealed: after the dural incision, the superficial lesion showed mild adhesion of the cerebral cortex to the dura mater, showing a slight yellow and localized swelling. 3. Resection of the lesion: Select the lesion to cut the cortex from the shallowest part of the cortex. After the lesion is found, the surrounding area is protected with cotton sheets. Once the lesion is removed, the cheese-like tissue overflows to prevent the spread of infection. Generally, the lesion should be separated under the operating microscope, and no block resection should be performed to obtain a complete excision; however, the movement and speech area lesions, such as separation difficulties, can only be stopped. 4. After the lesion is removed, the wound is washed with streptomycin dilution and the skull is sutured layer by layer. complication Tuberculous meningitis Tuberculous meningitis is the most common complication after surgery. Once the symptoms of meningitis occur, it should be controlled by regular use of anti-tuberculosis drugs. 2. Hydrocephalus Feasible ventriculo-peritoneal shunt. 3. Brain palsy Mainly due to severe cerebral edema after surgery, hormones, dehydration, etc. can be used, and emergency decompression of large bone flaps is considered.