CT-directed Stereotactic Surgery in the Management of Brain Abscess Burton L. Wise, MD, and Curtis A. Gleason, PhD CT-directed stereotactic tapping was used successfully to treat a deep brain abscess, as described in the following report.
A 56-year-old physician who had had headaches and fever for eight days was found to have a right homonymous visual field defect and moderate aphasia. Initial CT scan delineated an irregular, multilocular lesion deep in the left parietooccipital area. Treatment with penicillin and chloramphenicol was continued for nine days, when repeat CT scan demonstrated that the entity had coalesced to one large lesion with a thicker wall, and seemed larger (Fig 1). Two days later stereotactic tapping of the abscess was done, with the coordinates determined directly from the CT scan. Four cubic centimeters of pus was aspirated, and the cavity was washed repeatedly with bacitracin solution. The organism was microaerophilic alpha streptococcus. Treatment with intravenous penicillin was continued for approximately six weeks. The neurological deficits gradually cleared except for a slight partial upper homonymous quadrant field defect, and CT scan 4y2 months later showed complete disappearance of the lesion (Fig 2).
Fig 1. C T Scan nine days after admission. A single large lesion w i t h a thick wall is seen.
The technique of deriving stereotactic coordinates directly from the CT scan has been described elsewhere [ 11. The method eliminates the contrast study-pneuis usually a moencephalogram or ventriculogram-that part of stereotactic procedures, making the operation simpler and safer. The technique has been useful in the biopsy of deep brain lesions and could also be used to inject drugs or isotopes into such lesions or to treat deep tumors by radiofrequency lesions or cryosurgery.
Reference 1. Gleason CA, Wise BL, Feinstein B: Stereotactic localization (with computerized tomographic scanning), biopsy, and radiofrequency treatment of deep brain lesions. Neurosurgery 2:217-222, 1978
From the Department of Neurosciences, Mount Zion Hospital and Medical Center, PO Box 7921, San Francisco, CA 94120.
Accepted for publication June 11, 1979.
F i g 2 . CT scan a t 4 '/2 months. The lesion has resolved completely.
Notes and Letters
457
A 56-year-old physician who had had headaches and fever for eight days was found to have a right homonymous visual field defect and moderate aphasia. Initial CT scan delineated an irregular, multilocular lesion deep in the left parietooccipital area. Treatment with penicillin and chloramphenicol was continued for nine days, when repeat CT scan demonstrated that the entity had coalesced to one large lesion with a thicker wall, and seemed larger (Fig 1). Two days later stereotactic tapping of the abscess was done, with the coordinates determined directly from the CT scan. Four cubic centimeters of pus was aspirated, and the cavity was washed repeatedly with bacitracin solution. The organism was microaerophilic alpha streptococcus. Treatment with intravenous penicillin was continued for approximately six weeks. The neurological deficits gradually cleared except for a slight partial upper homonymous quadrant field defect, and CT scan 4y2 months later showed complete disappearance of the lesion (Fig 2).
Fig 1. C T Scan nine days after admission. A single large lesion w i t h a thick wall is seen.
The technique of deriving stereotactic coordinates directly from the CT scan has been described elsewhere [ 11. The method eliminates the contrast study-pneuis usually a moencephalogram or ventriculogram-that part of stereotactic procedures, making the operation simpler and safer. The technique has been useful in the biopsy of deep brain lesions and could also be used to inject drugs or isotopes into such lesions or to treat deep tumors by radiofrequency lesions or cryosurgery.
Reference 1. Gleason CA, Wise BL, Feinstein B: Stereotactic localization (with computerized tomographic scanning), biopsy, and radiofrequency treatment of deep brain lesions. Neurosurgery 2:217-222, 1978
From the Department of Neurosciences, Mount Zion Hospital and Medical Center, PO Box 7921, San Francisco, CA 94120.
Accepted for publication June 11, 1979.
F i g 2 . CT scan a t 4 '/2 months. The lesion has resolved completely.
Notes and Letters
457
