Controversies in the management of subdural empyema

Pathak, Ashish; Sharma, Bhawna; Mathuriya, S. N.; Khosla, Virender K.; Khandelwal, Niranjan; Vk, Kak

doi:10.1007/bf01402182

Cited by 61 publications

(12 citation statements)

References 50 publications

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“…CSOM was the commonest identifiable source in our series, in concordance with the reported experiences with intracranial SDEs on the Indian subcontinent [8, 10]. Spread of infection to the subdural space from an otorhinogenic source was first described by Courville [11] who postulated that direct spread may occur by erosion through the posterior wall of the frontal sinus and indirect spread (commoner) by retrograde thrombophlebitis involving the valveless interconnecting venous systems of both the extra- and intracranial spaces.…”

Section: Discussionsupporting

confidence: 76%

“…Intracranial SDE, usually supratentorial, is a common disease entity in developing countries [7, 8]. In spite of this condition being common in the pediatric age group, there is a paucity of literature in terms of case series focusing purely on the pediatric population with previous series of 8, 22 and 28 cases being published by Pattisapu and Parent [1], Smith and Hendrick [2], and Yilmaz et al [3] respectively; this series of 65 patients being the largest series in the English literature.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Supratentorial Subdural Empyemas: A Retrospective Analysis of 65 Cases

Banerjee¹,

Pandey²,

Devi³

et al. 2009

Pediatr Neurosurg

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Aim: Intracranial subdural empyemas (SDEs), the majority of which are supratentorial in location, are common neurosurgical emergencies in developing countries, especially in the pediatric age group. They result in significant morbidity and mortality despite improvements in neuroimaging, surgical techniques and antibiotic therapy. In the present study, we retrospectively analyze our experience with operated cases of intracranial supratentorial SDEs in the pediatric age group. Patients and Methods: 65 pediatric patients (age ≤18 years) with supratentorial SDEs were treated in our institute between January 1988 and May 2006, and the case records analyzed with respect to clinical, radiological, bacteriological and surgical complications and outcome data. Results: There was a slight male preponderance (55%), with mean age being 9.54 ± 6.43 years (range 3 months to 18 years). Otogenic source was the most common identifiable etiology, followed by postmeningitic and rhinogenic sources. The initial surgical intervention, burr holes (44 patients; 67.7%) and craniotomy (21 patients; 32.3%), varied with individual cases and surgeon preference. Initial craniotomy was associated with lesser repeat procedures, and slightly better clinical outcome. The majority (83.3%) of patients with significant residual requiring repeat surgery were found to have undergone burr hole evacuation initially. The mortality rate in the present series was 10.8%. Follow-up was available for 41 patients (70.7%) with an average follow-up of 10.4 months. 88% of patients showed good outcomes (Glasgow Outcome Scores of 4 or 5) at the latest follow-up. Conclusion: Pediatric supratentorial SDEs, although rapidly fatal if not identified promptly, can be effectively managed with early surgical drainage (preferably craniotomy), eradication of the source, and sensitive broad-spectrum antibiotics (i.v.) with good outcomes.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Pediatric Supratentorial Subdural Empyemas: A Retrospective Analysis of 65 Cases

Banerjee¹,

Pandey²,

Devi³

et al. 2009

Pediatr Neurosurg

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“…Intracranial supratentorial subdural empyema is a common disease entity in developing countries [32,33]. Previous series of 8, 22 and 28 cases have been published by Pattisapu and Parent [33], Smith and Hendrick [34] and Yilmaz et al [35] respectively.…”

Section: Discussionmentioning

confidence: 99%

Focal Intradural Brain Infections in Children: An Analysis of Management and Outcome

Madhugiri

Sastri

Srikantha³

et al. 2011

Pediatr Neurosurg

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Introduction: Focal intradural infections of the brain include empyema and abscess in the supratentorial and infratentorial spaces. These are amenable to surgical management. Various other issues may complicate the course of management, e.g. hydrocephalus with infratentorial lesions or cortical venous thrombosis with supratentorial lesions. Here, we review the management and identify factors affecting outcome in these patients. Materials and Methods: This is a retrospective analysis of all children (aged <18 years) treated at the National Institute of Mental Health and Neurosciences, Bangalore, India, between 1988 and 2004. Case records were analyzed to obtain clinical, radiological, bacteriological and follow-up data. Results: There were 231 children who underwent treatment for focal intradural abscess/empyema at our institute. These included 57 children with cerebral abscess, 65 with supratentorial empyema, 82 with cerebellar abscess and 27 with infratentorial empyema. All patients underwent emergency surgery (which was either burr hole and aspiration of the lesion or craniotomy/craniectomy and excision/evacuation), along with antibiotic therapy, typically 2 weeks of intravenous and 4 weeks of oral therapy. The antibiotic regimen was empiric to begin with and was altered if any sensitivity pattern of the causative organism(s) could be established by culture. Hydrocephalus was managed with external ventricular drainage initially and with ventriculoperitoneal shunt if warranted. Mortality rates were 4.8% for cerebral abscess, 9.6% for cerebellar abscess, 10.8% for supratentorial subdural empyema and 3.7% for posterior fossa subdural empyema. The choice of surgery was found to have a strong bearing on the recurrence rates and outcome in most groups, with aggressive surgery with craniotomy leading to excellent outcomes with a low incidence of residual/recurrent lesions. Conclusions: Antibiotic therapy, emergency surgery and management of associated complications are the mainstays of treatment of these lesions. We strongly advocate early, aggressive surgery with antibiotic therapy in children with focal intradural infections.

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“…In our study, one of the presenting signs of SDE was a tonicclonic seizure that stopped rapidly by IV diazepam and with a prophylactic dose of phenytoin; in the duration of hospitalization, convulse did not happen. Seizures (focal or generalized) have been reported in about 50% of patients (30,31). Therefore, some studies and centers recommend the prophylactic anticonvulsants (12,13,15,32).…”

Section: Discussionmentioning

confidence: 99%

Brain Infection After Cesarean Section: A Case of Subdural Empyema Post-Cesarean Section

2018

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We report a rare case of parieto-frontal subdural empyema after a cesarean section. A 23-year-old woman with a history of cesarean section, two weeks prior to admission, presented to the emergency room with the chief complaint of a headache, fever (39.5°C), nausea, vomiting, aphasia, tonic colonic movement, and a Glasgow coma scale score of 10/15 two weeks after a cesarean section. A subdural fluid collection in parieto-frontal on the left side was demonstrated in the brain MRI. She received rapidly an anticonvulsant drug (diazepam) and empirical board-spectrum antibiotics (vancomycin, metronidazole, and ceftriaxone) and subsequently underwent an urgent craniotomy. Antibiotic therapy continued for 4 weeks, the patient symptoms and signs improved, and she was discharged with a Glasgow coma scale score of 15/15 without neurological deficit and seizure.

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Controversies in the management of subdural empyema

Cited by 61 publications

References 50 publications

Pediatric Supratentorial Subdural Empyemas: A Retrospective Analysis of 65 Cases

Pediatric Supratentorial Subdural Empyemas: A Retrospective Analysis of 65 Cases

Focal Intradural Brain Infections in Children: An Analysis of Management and Outcome

Brain Infection After Cesarean Section: A Case of Subdural Empyema Post-Cesarean Section

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