firearms brain abscess surgery

During the first and second world wars, the time of debridement of craniocerebral firearm injuries was later, usually only a few days after the injury or even weeks, and in the X-ray examination of the skull after debridement, many wounded brains There are still some bone fragments remaining, and the incidence of brain abscess is as high as 15% to 20%. During the local wars of the world in the 1950s and 1960s, the US military specialist team reached the battlefield. In the battlefield of Vietnam, the US military directly sent the wounded to the second-line hospital by helicopter to the fire line. The brain wounded patients can do brain debridement surgery 2 to 3 days after the injury or within a few hours after the injury, and emphasize the bone in the brain. All the tablets were removed as the standard for thorough brain debridement, and the incidence of brain abscess was reduced to about 5%. Most of the causes of brain abscess are caused by broken bone fragments in the brain, especially in the dense parts of the bone fragments in the brain. A small number of large shrapnel and bullets (heads) that occur above 1 cm are generally considered to be in the brain. Broken bone fragments and large metal foreign bodies are the main targets of brain debridement. Cerebral angiography and CT examination are quite accurate in the diagnosis of brain abscess, but there is no such condition in wartime. It is also necessary to diagnose by clinical symptoms and the location of broken bone fragments in the brain. Once diagnosed as a brain abscess, surgery is required. Common surgical methods include abscess drainage including pouch suture and abscessectomy. It is generally necessary to remove the abscess and the bone fragments and metal foreign bodies causing the abscess at the same time or in stages to eliminate the recurrence of the brain abscess. Treatment of diseases: firearm-induced head injury Indication Firearms and brain abscess surgery is applicable to: 1. For more than 1 week of injury, brain debridement has not occurred, and the injured person has intracranial hypertension, or hemiplegia, aphasia, or the original symptoms gradually increase without CT examination conditions, surgical exploration should be performed. 2, after the brain debridement, there is still left bone fragments, the wounded have increased intracranial hypertension and focal symptoms. 3, the head wound does not heal for a long time, there are a lot of purulent secretions, when the pus outflow decreases, the symptoms of the wounded are aggravated, suggesting that the sinus abscess in the brain is enlarged, and should be surgically removed after sinus angiography or CT scan. 4, a small amount of bone fragments or shrapnel in the deep part of the brain, due to fear of surgery to aggravate brain damage and discharge from the hospital, regular review of CT, once found in the center of low density and surrounding ring-enhanced lesions, surgery should be. Contraindications 1. Intracranial and systemic inflammatory manifestations of craniocerebral wounds. CT and MRI examinations prove that intracranial infection is still in the encephalitis period. At this time, it is not suitable for surgery and antibiotic control. 2, brain abscess through the ventricle, causing suppurative ventriculitis and meningitis, the patient is in a state of exhaustion. Preoperative preparation 1. Prepare the skin, wash the head with soap and water first, and shave the head on the eve of surgery. Fasting before surgery. One hour before the operation, 0.1 g of phenobarbital, 0.4 mg of atropine or 0.3 mg of scopolamine were intramuscularly injected. 2. CT scan when conditions are available to understand the size and location of brain abscess. Surgical procedure 1, surgical incision In general, the surgical incision of the original brain debridement is used, and a more suitable incision can be designed. 2, skull and meningeal treatment The bone window of the original brain debridement can be appropriately enlarged if necessary for surgery. The brain and meninges at the wound have healed together, and it is no longer necessary to peel off the meninges at the time of surgery to prevent the spread of infection. 3, abscess clearance For abscesses with sinus, they should enter along the sinus, use the vascular clamp to gently enlarge the stenosis of the sinus, or remove obstructive foreign body to make the drainage clear. The abscess that is still weak in the capsule gradually deepens along the injured path. When the abscess is reached, a part of the pus is sucked by a syringe, and the silicone tube with the side hole is accurately placed into the abscess cavity. The multi-room abscess should be opened. At intervals, after the abscess is cured, the bone fragments that cause the abscess are removed by surgery. 4, incision treatment The abscess drainage and the scalp incision of the bag-shaped suture were not sutured or sutured at both ends; the abscess was completely removed, and the scalp of the wound was partially sutured. complication 1, purulent meningitis Caused by pus contamination. Use antibiotics that are sensitive to bacteria or that can cross the blood-brain barrier, such as ceftriaxone. 2, purulent ventriculitis The abscess broke into the ventricle. In addition to systemic medication, lateral ventricle puncture and lumbar puncture can be performed simultaneously, and a large amount (250-500 ml) of physiological saline solution containing antibiotics (cefazolin sodium 0.25 g) is dripped from the ventricle, and the lumbar puncture needle is discharged at the same flow rate. , ventricle and subarachnoid irrigation.