Early multimodality treatment of intracranial abscesses

Background: The treatment of brain abscesses remains one of the success stories of contemporary neurosurgery; what began as a nearly uniformly fatal disease at the turn of the 20th century has become a largely curable ailment through the use of operative and pharmaceutical intervention. Methods: Following institutional review board approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical files of the Johns Hopkins Hospital, 1896 to 1912, were reviewed. Results: A total of six patients were operated on for intracranial abscesses. Three patients died during their admission, the remaining three were discharged with a condition listed as "improved" or "well." Conclusions: Cushing employed a variety of operative drainage techniques for intracranial abscesses and implemented an early antibacterial agent to provide adjuvant treatment in one patient. Although these cases demonstrate a 50% mortality rate, they provide insight into the challenges faced by neurosurgeons treating intracranial abscesses at the turn of the 20th century.