[The brain abscess today]

In spite of refined diagnostic and therapeutic possibilities, the cerebral abscess continues to be a disease involving great risks. A comparison of surgically treated groups of patients of the periods 1954 to 1962 and 1963 to 1977 does not show any reduction in lethality. This amounted to 15 per cent for the first group and 17.6 per cent for the second group. Extirpation of cerebral abscesses shows the most favourable results of treatment as compared to other surgical procedures. In our opinion, however, it will not remain the only method of treatment in future because it can only be employed if the patient is in a condition permitting an operation. That is why the open abscess treatment will continue to be justified for all cases where cerebral abscesses occur in combination with subdural or epidural empyemas. Certainly, modern anaesthesia methods as well as intensive pre- and postoperative therapy will further reduce the number of patients who are subjected to a primary puncture treatment. Since 1972, we have treated our patients exclusively by abscess exstirpations. Until 1977, none of the total number of 12 patients treated by us has died. We consider the use of scintigraphic and EEG controls of inflammatory cerebral processes to be of decisive importance. These controls enable a differentiation between diffuse and local inflammatory processes which are accompanied by a liquefaction and in this way permit the selection of the optimum time of operation. A basic condition, however, will always be a good interdisciplinary co-operation with infection departments, paediatric and ENT hospitals where in most cases patients suffering from brain abscesses are first admitted.