Alderson D, Strong A J, Ingham H R, Selkon J B
Neurosurgery. 1981 Jan;8(1):1-6. doi: 10.1227/00006123-198101000-00001.
Ninety consecutive cases of brain abscess admitted to this center between 1964 and 1978 have been reviewed. The overall mortality has fallen in three consecutive 5-year periods from 42 to 21 to 9.7%. A number of factors seem to be responsible for this. Early surgical intervention was associated with the reduction in mortality between the first and second 5-year periods. Recognition of the significance and extent of cerebral edema, confirmed since computed tomographic (CT) scans have been available, led to a greater use of steroids during the last 5-year period, but the number of patients thus treated was too small to permit an assessment of any effect on mortality. There is no evidence to suggest a change in the natural history of the disease, and surgical management has not altered significantly. Experience with CT scanning in this center in the diagnosis of brain abscess is limited. It is therefore not possible no assess whether any improvement in mortality may have arisen from the early and accurate diagnosis obtainable with this technique. Improvement in culture technique has been of major importance, leading to a better understanding of the bacteriology of brain abscesses. This has allowed a more rational antibiotic program to be instituted, in particular the use of agents active against obligate anaerobes.
回顾了1964年至1978年间收治于本中心的90例连续性脑脓肿病例。总体死亡率在连续三个5年期间从42%降至21%，再降至9.7%。有多个因素似乎对此负责。早期手术干预与第一个和第二个5年期间死亡率的降低相关。自从有了计算机断层扫描（CT）以来，对脑水肿的重要性和范围的认识得以确认，这使得在最后一个5年期间更多地使用了类固醇，但接受此类治疗的患者数量过少，无法评估其对死亡率的任何影响。没有证据表明该病的自然史发生了变化，手术管理也没有显著改变。本中心在脑脓肿诊断中使用CT扫描的经验有限。因此，无法评估通过该技术获得的早期准确诊断是否可能使死亡率有所改善。培养技术的改进至关重要，这使得对脑脓肿细菌学有了更好的理解。这使得能够制定更合理的抗生素方案，特别是使用对专性厌氧菌有效的药物。
