Petit H, Rousseaux M, Lesoin F, Destée A, Clarisse J, Warot P
Rev Neurol (Paris). 1983;139(10):575-81.
Therapy in 19 consecutive cases of cerebral abscess was limited to medical treatment whenever possible, using high doses of a combination of several antibiotics. Long-term follow up by serial computed tomography was performed. Antibiotic treatment alone was effective in 8 patients with multiple hemispheric abscesses of metastatic origin, though one patient seen late with three large abscesses die on the 4th day. In 8 cases with single abscesses, medical treatment alone was effective: 5 had lesions less than 4 cm in diameter; in 2 cases with lesions 4 to 5 cm in diameter, additional abscess puncture was carried out. One patient required early excision of an occipital abscess, and 2 cases of pontocerebellar angle abscesses were also treated surgically. Antibiotic therapy alone was effective in 1 patient with a large brain stem abscess. Treatment of cerebral abscess has largely changed since the availability of computed tomography, with a progressively more important place being accorded to antibiotic therapy alone. The stage of the abscess does not appear to be a decisive factor in the choice of treatment, medical therapy appearing to provide a definitive cure with a minimum of sequelae in the majority of cases. Abscess puncture may be an adjunct to antibiotic therapy in large abscesses with clinical signs.
对19例脑脓肿患者，只要有可能，治疗就仅限于药物治疗，使用大剂量的几种抗生素联合用药。通过连续计算机断层扫描进行长期随访。单独使用抗生素治疗对8例转移性多半球脓肿患者有效，不过有1例晚期出现3个大脓肿的患者在第4天死亡。在8例单发性脓肿患者中，单独药物治疗有效：5例病灶直径小于4厘米；2例病灶直径为4至5厘米，额外进行了脓肿穿刺。1例患者需要早期切除枕叶脓肿，2例桥小脑角脓肿也接受了手术治疗。单独使用抗生素治疗对1例脑干大脓肿患者有效。自从有了计算机断层扫描后，脑脓肿的治疗发生了很大变化，单独抗生素治疗的地位越来越重要。脓肿的阶段似乎不是治疗选择的决定性因素，在大多数情况下，药物治疗似乎能以最少的后遗症提供根治。对于有临床症状的大脓肿，脓肿穿刺可作为抗生素治疗的辅助手段。
