The Treatment of Encapsulated Brain Abscess

Although there has been advance in the treatment of brain abscess by modern methods, the mortality still remains strikingly higher than that reported by Macewen¹in 1893. In recent years my associates and I have been using with slight modifications the method described by King²in 1924. This consists of direct transcortical exposure of the abscess, uncapping the presenting wall and packing of the cavity in one stage. The increased intracranial pressure then theoretically everts the abscess wall. Though we feel that this is the best method to date, we have had our share of failures, owing chiefly to technical difficulties arising in the treatment of deep-seated abscesses. The first of these difficulties lies in the fact that though the overlying brain is removed in the exposure of the abscess capsule there is still considerable trauma to the adjacent brain. The latter is not removed and may predispose