In children a study of thirty-two cases, no cage beiny included in which the pa tient was five years old or over, led to the conclusion: that on account of the great amount of shock attending brain surgery in very young children, an oper ation should not be urged unless definite localizing symptoms are present, the principal one being herniplegia. I.. E. Holt (Archives of Pediatrics, Mar., '9S).
In cerebral operations a large area of the skull should be removed. It both enables us to examine the brain better when exposed, and also, if benefit is to be obtained from relief of cerebral pres sure, it surely increases that chance; and also it scarcely increases the danger of the operation. E. D. Fisher (N. Y. Med. Jour., Apr. 16, '93).
Delay in operating until the appear ance of unequivocal localizing symptoms, or recourse merely to opening of the mastoid when it may be reasonably as sumed that cerebral abscess exists, is a far greater injustice to the patient than his subjection to an exploratory trephin ing of the cranium. Collins (Amer. Jour. of Med. Sci., Apr. '99).
It is important to determine the na ture of the micro-organism producing the abscess at as early a period as pos sible. A large opening in the skull recommended after first turning down a large scalp-flap. For the drainage of
an abscess in the temporo-sphenoidal lobe the trephine opening should be made Vs inch above the suprameatal spine. In operating for a cerebellar abscess the trephine should be placed with its upper edge just below Reid's base-line and its anterior edge touching the posterior border of the mastoid process. In incising the dura meter the opening should be made by a flap rather than by a crucial incision. The use of a long,narrow, straight bistoury recom mended for the exploration rather than the use of the exploring needle or can nula, as the incised wound of the brain heals better than the punctured wound. The finger is also to be used for ex ploration. Irrigation of an abscess of the brain should only be resorted to when there is free exit for the fluid, such as is accomplished by the use of a tube. Tamponing these cavities with gauze is not approved. Recurrence of syinptoms, especially in cerebellar ab scess, is not an uncommon thing a few days after the opening of a brain abscess, and it is due either to a retie cumulation of the fluid or else to an entirely new formation of pus in an other part of the same lobe. C. A. Bal lanee (Lancet, May 25, '1901).