The treatment of cranial osteomyelitis and brain abcess / Alfred W. Adson.

  • Adson, Alfred W. (Alfred Washington), 1887-1951.
Date:
[1938?]
Catalogue details

Licence: In copyright

Credit: The treatment of cranial osteomyelitis and brain abcess / Alfred W. Adson. Source: Wellcome Collection.

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    Volume 108 Number 4 CRANIAL OSTEOMYELITIS afflict children and young adults than is osteomyelitis of the inner table of the skull, since the outer table is more porous. Staphylococcus pyogenes aureus is chiefly responsible for osteomyelitis resulting from infections of the frontal sinus and is the organism which frequently produces the osteomyelitic proc¬ esses in compound comminuted fractures, with infected, lacerated wounds. The denuded skull, resulting from burns by electricity and fire, from ex¬ tensive lacerations, and from removal of the scalp because of tumors, ulti¬ mately, undergoes destructive processes. If the circulation to the inner table is intact, only the denuded outer table will degenerate and separate as a sequestrum.33 Craniotabes, gummatous osteomyelitis,1 caused by syphilis, is a representa¬ tive of the group of chronic infections. Eberthella typhi (Bacillus typhosus) at one time was a fairly common cause of osteomyelitis but today, since the introduction of vaccination, is rarely seen. An occasional case results from tuberculous involvement of the skull. Actinomycosis, too, occasionally is responsible for infective processes of the skull. Pathology.—The process of osteomyelitis begins with the introduction of suppurative organisms into the vascular channels of the skull. If the bone is denuded of its scalp, the process will extend until adequate circulation is encountered. Frequently, accompanying cellulitis will destroy the circulation of the scalp about the denuded bony area and this further encourages exten¬ sion of the osteomyelitis. The serpiginous extension along diploic canals will give rise to additional areas of necrosis beyond the original focus.35 The infection of diploic veins results in thrombosis and the development of granu¬ lation tissue. This process may extend either to the pericranial or to the intracranial structures by extension along emissary veins. Phlegmons of the scalp develop over the necrotic bony areas and extend the infection over suture lines to new areas, through emissary and diploic veins, thus giving rise to additional osteomyelitic processes.28 The disease may progress until the entire skull has been involved. On examination of the skull, islands of normal bone will be found between necrotic and sequestrated areas. These islands apparently have resisted the infection, owing to the fact that the circulation has been maintained and that a zone of granulation has served as a barrier in limiting the infection in the diploic canals. The reparative process of granulation and absorption works in conjunction with the destructive process. As the bony cells die they disintegrate, are ab¬ sorbed and are replaced by granulation tissue. This is readily demonstrated in a denuded area of skull. The exposed bone at first appears dry and dead- white, but sooner or later a zone, or ring, of granulation will appear at the scalp margin. In the zone of granulation there will develop a localized osteo¬ myelitis which eventually destroys a ring of bone in the outer table of the skull. When this has taken place, the granulation tissue in the diploic spaces will actually lift from the dead-white outer table of the denuded skull (Fig. i). Removal of the granulation tissue will reveal that the inner table is usually intact and is very vascular, owing to the fact that its circulation has been main-
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