Open evacuation of pus: a satisfactory surgical approach to the problem of brain abscess?

The operative management of intracerebral abscesses remains controversial, with both primary radical excision and repeated aspiration having their advocates. This paper describes a surgical technique which combines the advantages while avoiding the disadvantages of the two surgical approaches. At open operation the abscess is widely incised, all pus removed from within the capsule and any daughter loculi under direct vision and the empty capsule irrigated with antibiotic solution before closure of the wound without drainage. Fifteen cases were treated by this method. There were no deaths, 13 patients made full neurological recoveries and two were left partially disabled. In only one case was a second operation necessary to remove pus which had re-formed after an adequate primary clearance. There were no cases of wound sepsis or of late recurrence of the abscess.