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August 1967, Vol 114, No. 2 >
Article | August 1967

Management of Brain Abscesses in Children and Adolescents FREE

R. Lewis Wright, MD; H. Thomas Ballantine, MD
[+] Author Affiliations

Received for publication Sept 14, 1966.

Read before the meeting of the American Academy of Neurological Surgeons, San Francisco, Oct 17 to 19, 1966.

Reprint requests to Neurological Surgery, Massachusetts General Hospital, Boston 02114 (Dr. Wright).


Am J Dis Child. 1967;114(2):113-122. doi:10.1001/archpedi.1967.02090230043001.
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DESPITE modern antiobiotic therapy, brain abscess, unlike many other bacterial diseases, has remained a treacherous, life-threatening condition. In recent series, the mortality has remained from 25% to 50% in spite of improvements in technical operative skills, the range of available and effective antimicrobial drugs, and agents to lessen cerebral edema.1-6 In the present study, we have reviewed the experiences of the Neurosurgical Service at the Massachusetts General Hospital with 30 consecutive patients with brain abscesses not older than 17 who were seen in the period 1946 through 1965.

Occurrence  In contrast to the experience reported at other medical centers, there has been no tendency for the number of brain abscesses to diminish at this hospital in the period covered by this study despite improved agents for treating bacterial infections elsewhere in the body.2 Fifteen, or one half of the cases, were seen in the first decade of the

REFERENCES

1 +
Allen, P.B., and Speakman, T.J.:  Brain Abscess: Evaluation of Current Treatment , Canad Med Assoc J 86:852-854, 1962;.
2 +
Ballantine, H.T., Jr., and Shealy, C.N.:  The Role of Radical Surgery in Treatment of Abscess of the Brain , Surg Gynec Obstet 109:370-374, 1959;.
3 +
Ballantine, H.T., Jr., and White, J.C.:  Brain Abscess: Influence of the Antibiotics on Therapy and Mortality , New Eng J Med 248:14-19, 1953;.
4 +
Kerr, F.W.; King, R.B.; and Meagher, J.N.:  Brain Abscess: A Study of 47 Consecutive Cases , JAMA 168:868-872, 1958;.
5 +
Liske, E., and Weikers, N.J.:  Changing Aspects of Brain Abscesses , Neurology 14:294-300, 1964;.
6 +
Loeser, E., Jr., and Scheinberg, L.:  Brain Abscesses: Review of 99 Cases , Neurology 7: 601-609, 1957;.
7 +
Huang, S.H.; Hakuba, A.; and Okazaki, A.: Surgical Hematogenous Pyogenic Infection of the Brain in Infants and Its Etiology, presented at the 34th meeting of the Harvey Cushing Society, St. Louis, April 1966.
8 +
Tucht, W.:  Brain Abscess in Infancy , Zbl Neurochir 21:278-286, 1961;.
9 +
Dodge, P.R., and Swartz, M.N.:  Bacterial Meningitis: A Review of Selected Aspects: 2. Special Neurologic Problems, Postmeningitis Complications, and Clinicopathological Correlations , New Eng J Med 272:954-960, 1965;.
10 +
Fincher, E.F.:  Craniotomy and Total Dissection as a Method in the Treatment of Abscess of the Brain , Ann Surg 123:789-807, 1946;.
11 +
LeBeau, J.:  Radical Surgery and Penicillin in Brain Abscess: A Method of Treatment in One Stage With Special Reference to the Cure of Three Thoracogenic Cases , J Neurosurg 3: 359-374, 1946;.
12 +
Hawkes, C.D.:  "Inflammatory Diseases,"  in Jackson, I.J., and Thompson, R.K. (eds.): Pediatric Neurosurgery , Springfield, Ill: Charles C Thomas, Publisher, 1959;, pp 166-189.
13 +
Matson, D.D., and Salam, M.:  Brain Abscess in Congenital Heart Disease , Pediatrics 27:772-789, 1961;.
14 +
Mount, L.A.:  Conservative Surgical Therapy of Brain Abscesses , J Neurosurg 7:385-389, 1950;.
15 +
Sachs, E.:  Analysis of Brain Abscesses Observed During the Past 30 Years , Ann Surg 123: 785-788, 1946;.
16 +
Sperl, M.P., Jr.; MacCarty, C.S.; and Wellman, W.E.:  Observations on Current Therapy of Abscess of the Brain , Arch Neurol Psychiat 81:439-441, 1959;.
17 +
Wright, R.L.:  A Survey of Possible Etiologic Agents in Postoperative Craniotomy Infections , J Neurosurg 25:125-132, 1966;.
18 +
Wright, R.L.: Postoperative Craniotomy Infections , Springfield, Ill: Charles C Thomas, Publisher, 1966;.
19 +
Northcroft, G.B., and Wyke, B.D.:  Seizures Following Surgical Treatment of Intracranial Abscesses: A Clinical and Electroencephalographic Study , J Neurosurg 14:249-263, 1957;.
20 +
Matthijs, R.:  Le devenir des abces encephaliques traites par les techniques neurochirurgicales: Etude clinique et electroencephalographique de 103 observations , Acta Neurol Belg 63:583-735, 1963;.

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References

1 +
Allen, P.B., and Speakman, T.J.:  Brain Abscess: Evaluation of Current Treatment , Canad Med Assoc J 86:852-854, 1962;.
2 +
Ballantine, H.T., Jr., and Shealy, C.N.:  The Role of Radical Surgery in Treatment of Abscess of the Brain , Surg Gynec Obstet 109:370-374, 1959;.
3 +
Ballantine, H.T., Jr., and White, J.C.:  Brain Abscess: Influence of the Antibiotics on Therapy and Mortality , New Eng J Med 248:14-19, 1953;.
4 +
Kerr, F.W.; King, R.B.; and Meagher, J.N.:  Brain Abscess: A Study of 47 Consecutive Cases , JAMA 168:868-872, 1958;.
5 +
Liske, E., and Weikers, N.J.:  Changing Aspects of Brain Abscesses , Neurology 14:294-300, 1964;.
6 +
Loeser, E., Jr., and Scheinberg, L.:  Brain Abscesses: Review of 99 Cases , Neurology 7: 601-609, 1957;.
7 +
Huang, S.H.; Hakuba, A.; and Okazaki, A.: Surgical Hematogenous Pyogenic Infection of the Brain in Infants and Its Etiology, presented at the 34th meeting of the Harvey Cushing Society, St. Louis, April 1966.
8 +
Tucht, W.:  Brain Abscess in Infancy , Zbl Neurochir 21:278-286, 1961;.
9 +
Dodge, P.R., and Swartz, M.N.:  Bacterial Meningitis: A Review of Selected Aspects: 2. Special Neurologic Problems, Postmeningitis Complications, and Clinicopathological Correlations , New Eng J Med 272:954-960, 1965;.
10 +
Fincher, E.F.:  Craniotomy and Total Dissection as a Method in the Treatment of Abscess of the Brain , Ann Surg 123:789-807, 1946;.
11 +
LeBeau, J.:  Radical Surgery and Penicillin in Brain Abscess: A Method of Treatment in One Stage With Special Reference to the Cure of Three Thoracogenic Cases , J Neurosurg 3: 359-374, 1946;.
12 +
Hawkes, C.D.:  "Inflammatory Diseases,"  in Jackson, I.J., and Thompson, R.K. (eds.): Pediatric Neurosurgery , Springfield, Ill: Charles C Thomas, Publisher, 1959;, pp 166-189.
13 +
Matson, D.D., and Salam, M.:  Brain Abscess in Congenital Heart Disease , Pediatrics 27:772-789, 1961;.
14 +
Mount, L.A.:  Conservative Surgical Therapy of Brain Abscesses , J Neurosurg 7:385-389, 1950;.
15 +
Sachs, E.:  Analysis of Brain Abscesses Observed During the Past 30 Years , Ann Surg 123: 785-788, 1946;.
16 +
Sperl, M.P., Jr.; MacCarty, C.S.; and Wellman, W.E.:  Observations on Current Therapy of Abscess of the Brain , Arch Neurol Psychiat 81:439-441, 1959;.
17 +
Wright, R.L.:  A Survey of Possible Etiologic Agents in Postoperative Craniotomy Infections , J Neurosurg 25:125-132, 1966;.
18 +
Wright, R.L.: Postoperative Craniotomy Infections , Springfield, Ill: Charles C Thomas, Publisher, 1966;.
19 +
Northcroft, G.B., and Wyke, B.D.:  Seizures Following Surgical Treatment of Intracranial Abscesses: A Clinical and Electroencephalographic Study , J Neurosurg 14:249-263, 1957;.
20 +
Matthijs, R.:  Le devenir des abces encephaliques traites par les techniques neurochirurgicales: Etude clinique et electroencephalographique de 103 observations , Acta Neurol Belg 63:583-735, 1963;.

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