brain abscess resection

The so-called brain abscess refers to those caused by bacteria. All purulent bacteria invade the brain, causing purulent inflammation of the brain, and localized the formation of the abscess, called brain abscess. Its incidence accounts for about 1.3% of the total number of inpatients in neurosurgery. Brain abscesses occur mostly on the screen, rare under the curtain, can occur at any age, but the majority of youth. The path of infection of brain abscess is: 1 otogenic brain abscess, which occurs mostly in temporal lobe, followed by cerebellum, and occasionally in frontal lobe, parietal lobe and occipital lobe. It is more common in chronic otitis media, and most brain abscesses are Single hair, a small number can be multiple or multiple atrial. 2 blood-borne brain abscess (also known as metastatic brain abscess), is the infection of the brain away from the brain after the embolism fell off with the blood to the brain to form an abscess. The embolus can enter the white matter of the brain through the arterial, venous or spinal venous plexus, which in turn forms an abscess. 3 traumatic brain abscess, foreign body contaminated by craniocerebral firearms and broken bone pieces directly into the brain, or in the usual open injury, skull base fracture, bacteria through the wound or air sinus directly into the brain to form an abscess. 4 nasal brain abscess, mostly caused by frontal sinusitis, ethmoid sinusitis, maxillary sinusitis and sphenoid sinusitis, but less common. 5 cryptogenic brain abscess. Since the original infection is hidden or disappeared, the source of the infection is difficult to identify. Strictly speaking, it should be a blood-borne brain abscess. Clinically, it is often hospitalized by brain tumors, confirmed by surgery or surgery. According to the speed and severity of the disease, brain abscess can be divided into acute brain abscess (burdenous brain abscess) and chronic brain abscess. Clinically, the formation of brain abscess is divided into three phases, namely, acute encephalitis, suppuration and abscess formation. Because of the sooner or later, the size and location of brain abscess formation, the symptoms often vary widely. In order to diagnose early, in the inquiry of the medical history, attention should be paid to the presence or absence of suppurative lesions and the corresponding signs and symptoms. In time, the X-ray, CT and MRI examinations can be performed in time to provide accurate positioning and qualitative basis, and diagnosis. It is not difficult. Once the brain abscess is diagnosed, the main treatment is surgery, and at the same time systemic antibiotics and supportive therapy. General surgical methods include: brain abscess puncture, drainage and resection. Usually, most advocate the use of simple and small damage to brain tissue, if not effective, then consider surgical resection. Treatment of diseases: brain abscess Indication 1. Abscess is not located in the important functional area of the brain, generally stable, and the capsule formation is good. 2. Repeated puncture or drainage after drainage is not completely cured. 3. Multiple atrial abscess or adjacent multiple abscess. 4. Traumatic abscess with foreign body and broken bone fragments. 5. Recurrent brain abscess or abscess through the ventricles. Preoperative preparation 1. There must be a correct positioning diagnosis before surgery. The relationship between the location of the lesion and the surrounding structure should be analyzed before surgery in order to select the appropriate surgical approach, to obtain the best exposure, avoid the important structure of the skull as much as possible, increase the safety of the operation and strive for good Effect. 2. Skin preparation, wash the head with soap and water 1 day before the operation, shave the hair on the morning of the operation. You can also shave your head on the eve of surgery. 3. Fasting the morning of surgery. 4. Give phenobarbital 0.1g orally before surgery to ensure a quiet rest. One hour before the operation, 0.1 g of phenobarbital, 0.4 mg of atropine or 0.3 mg of scopolamine were intramuscularly injected. Surgical procedure Incision Craniotomy flap craniotomy was used. Same as general craniotomy. Cut the opening skin, electrocoagulation to stop bleeding, hemostasis or scalp clip to stop bleeding, open the flap, saline gauze pad protection, fixed flap. If surgery is performed on the skull defect area, a flap that can achieve resection of the abscess without affecting cerebral ischemic necrosis should be designed. Cerebellar abscess often takes a mid-canal incision or a straight incision in the midline. 2. Bone craniotomy Generally, 4 skulls are drilled, sawed and opened. 3. Cut the dura mater The elbow is cut open in a curved shape, turned to the midline side, and the brain cotton is protected. 4. Abscess positioning According to the position of the abscess displayed by CT or MRI, it can be gently touched on the surface of the brain. Generally, the cerebral cortex is swollen, the sulci is shallow, the cerebral gyrus is flattened, and the brain area of the superficial abscess is yellow. The local area is soft or cystic. Select the dumb area, after electrocoagulation to stop bleeding, try to detect with a brain needle, generally do not wear the wall of the abscess. If the abscess has a large tension and a thin wall, it is estimated that it is easy to break in the separation, and some pus can be taken out first, and the bacteria culture is left. 5. Cut the cortex It is generally chosen to coagulate the surface vessels at the shallowest cortex from the abscess. The needle path along the puncture is cut from shallow to deep and is cut open to the wall of the abscess with an aspirator. 6. Excision of abscess After the abscess is revealed, the brain cotton is placed along the abscess capsule, and the abscess is gradually exposed and freed from shallow to deep. If you encounter deep abscess or adhesion with important structures and skull base, it is feasible to puncture and puncture decompression. When the abscess volume is reduced and the tension is reduced, the abscess wall is clamped and the abscess is gradually removed. Occasionally, although the abscess is severely adhered after puncture and drainage, the capsule can not be completely removed, and the residual small envelope can be electrocoagulated. Cerebellar abscess resection is essentially the same as cerebral hemispheric abscess resection. If the abscess is closely related to the corresponding important structure, blood vessels and nerves, it should not be forcibly stripped and pulled. After most of the abscess wall is removed, the segmental capsule is removed to ensure safety. 7. Abscess bed treatment After the abscess is removed, the bipolar electrocoagulation is used to completely stop the bleeding in the cavity, or the hemostasis is covered with 3% hydrogen peroxide brain cotton tablets, and then repeated with gentamicin solution (500 ml normal saline plus gentamicin solution 160,000 U). rinse. 8. Guan skull After the on-screen abscess is removed, the brain beats well and there is no swelling. The dura mater is sutured and the bone flap is reset. The epidural rubber is placed in a hollow hollow drainage, and the scalp is sutured in two layers, and the drainage tube is taken out outside the incision. If the brain abscess is cleared, the cerebral edema is still obvious, the intracranial pressure is still high, or there is a cerebral palsy before surgery. The bone flap should be decompressed without suturing the dura mater, but the cap aponeurosis and skin should be sewn. Two floors. After the cerebellar abscess is removed, the craniotomy step is the same as that of the general cranial fossa craniotomy. complication 1. Suppurative meningitis, ventriculitis, caused by intraoperative contamination or abscess penetration into the ventricles. 2. Abscess recurrence, due to poor drainage or premature drainage tube removal. 3. Hemiplegia, aphasia, epilepsy, etc.