Brain abscess puncture and aspiration

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. The clinical diagnosis has been confirmed, and the puncture can be treated first. 2. Brain abscess is located in the deep or important functional area. 3. Critically ill patients or children with brain abscess, can not tolerate larger surgery. 4. The course of the disease is short, and the imaging shows that the abscess wall is thinner. Contraindications 1. Multi-atrial brain abscess. 2. The thickness of the capsule is small, and the brain abscess is small. 3. The abscess broke into the ventricles. Preoperative preparation Apply antibiotics as early as possible and in sufficient quantities. Surgical procedure Incision After the positioning is clear, select a 3 to 4 cm long incision from the scalp closest to the abscess and away from the functional area, stop bleeding, and open the incision with an automatic skin retractor. No incision can be made when applying the cranial cone. 2. Skull drilling The periosteum of the skull was cut and peeled off with a periosteal stripper. The skull was drilled with a sharp bit and a round drill to reveal the dura mater. It is also possible to apply a cranial cone to the skull cone. 3. Dural incision Electrocoagulation to stop bleeding, cut a small mouth with a sharp blade (or stop the dural hemorrhage with electrocoagulation, electrocoagulation of the scorpion from the shallow to the deep together with the cortical blood vessels to coagulate and stop bleeding), and then the cortical blood vessels to stop bleeding, ready for abscess puncture If the cone method is used, this step can be omitted. 4. Brain abscess puncture The brain is protected by the brain cotton around the cranial hole to prevent the abscess cavity from overflowing due to excessive pressure. The brain needle is used to puncture the abscess from shallow to deep. When the resistance is slightly increased, the pus cavity can be inserted into the abscess cavity. The pus is discharged, the brain needle is properly fixed, the pus is slowly taken out, the specimen is taken for bacterial culture and drug sensitivity test, and then the antibiotic saline is injected into the abscess. Rinse, avoid too fast, gravity wash. After the operation, the disinfectant barium sulfate contrast agent or iodophenyl ester plus 1 ml of antibiotic solution was injected, and the brain needle was removed. To prevent the empyema from overflowing, the needle should be gently applied after the needle is removed until the liquid is no longer liquid. Spill and suture the incision. 5.CT scan comparison CT scans were performed after surgery, and preoperative and postoperative comparisons were made for reference to the next treatment. The method used was the same as the first one when performing repeated puncture treatment. Do not separate the wound, just puncture the abdomen with a thicker brain puncture needle through the scalp and skull hole. Sometimes, in order to remove the cumbersome puncture, after the first puncture, a drainage tube (or double cannula) is introduced into the abscess for postoperative drainage and injection of antibiotics. The application of stereotactic instrumentation has its advantages. complication 1. Incision infection, osteomyelitis, epidural and subdural abscess. 2. Suppurative meningitis, ventriculitis. 3. Systemic sepsis or recurrence of brain abscess. 4. Hemiplegia, aphasia, epilepsy, etc.

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