Excerpt from Brain Abscess: Its Surgical Pathology and Operative Technic
Cushing, whose genius has transformed non-suppurative intra cranial surgery into comparatively safe, delicate, almost bloodless physiological procedures, has long contended that the ordinary surgical tec... hnic applicable to other parts of the body is insufficient to combat successfully the unique physiological factors and patho logical changes presented within the dura; and it is Cushing's tech nic which the author largely has used in operating for intracranial suppuration.
Surgically considered, intracerebral abscess stands in a class by itself, the problems presented in its surgical treatment differing from those of suppuration in other parts of the body and distinct from those encountered in the treatment of non-suppurative lesions of the brain. As many of the technical problems presented still remain far from solution, it is pro-posed to call attention to some of these physiological factors, their alteration by pathological proc esses, and the technic which, to the author's mind, most satisfactorily meets them. The success of intradural surgery always will depend upon utilizing every advantage offered by the preventive and reactive efi'orts of nature, while a single technical error may mean the loss of the patient's life or at least of his subsequent usefulness.
In this monograph the writer has attempted to correlate the surgical treatment of the different pathological lesions of brain ah sooss, for he believes that, although pathology and treatment usually are dealt with in separate chapters, they are in reality one and should be so considered. Certain it is that if one is to meet with even a moderate degree of success in the treatment of brain abscess, the surgical manipulation in each individual case must be adapted to the exact pathological condition present.
With this object in view emphasis is laid upon the pathology and on mechanical changes, and a classification is adopted which is capable of individual clinical recognition, because the author believes that our present knowledge should enable us not only confidently to diagnose the presence of brain abscess, but also in a large pro portion of the cases to determine its location and whether or not it is surrounded by a capsule.
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