Pediatric Supratentorial Subdural Empyemas: A Retrospective Analysis of 65 Cases

Banerjee, Anirban; Pandey, Paritosh; Devi, B Indira; Sampath, Sowmya; Chandramouli, B.A.

doi:10.1159/000202619

Cited by 37 publications

(27 citation statements)

References 30 publications

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“…31 English-language reports from India have described subdural empyema in childhood to be predominantly otogenic in origin and very often infratentorial in location. 5,27,39,43,56,61 Whether this interesting regional pattern of disease reflects phenotypic variation or environmental factors has not been explored.…”

Section: Discussionmentioning

confidence: 99%

Intracranial suppuration complicating sinusitis among children: an epidemiological and clinical study

Piatt¹

2011

PED

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Object Intracranial abscess is a very infrequent complication of sinusitis among children. Case series, mostly small and focusing on surgical treatment, have appeared in the literature, but there has been no study on the epidemiology of this condition, nor has there been any large-scale study on the intensity of therapy or outcomes. Methods Data were drawn from the Kids' Inpatient Databases for 1997, 2000, 2003, and 2006 and the National Inpatient Sample for 2001. Cases were defined by the conjunction between the diagnostic codes for intracranial abscess and those for acute or chronic sinusitis or mastoiditis. Results Eight hundred forty-seven hospital admissions were captured. Over the 10 years of the study, admission rates ranged between 2.74 and 4.38 per million children per year. Boys were affected much more commonly than girls. Black children were affected out of proportion to their presence in the population. The overall incidence seemed to peak in early adolescence. Sinogenic cases had a marked seasonal pattern peaking in winter, but no seasonal variation was seen for otogenic cases. Asthma comorbidity was more prevalent among sinogenic cases. The mortality rate was 2%, and death occurred only among sinogenic cases. Moreover, sinogenic cases tended to require more intensive therapy, as measured by the number of procedures, and there was a trend toward less favorable discharge dispositions. Older patients and black patients were less likely to be discharged directly to home. At least a quarter of the cases were managed without neurosurgical intervention. White patients were treated without neurosurgery more often than others. Conclusions Analysis of administrative data sets has yielded a descriptive picture of intracranial abscess complicating sinusitis among children, but the very low incidence of this condition impedes prospective clinical research directed at practical management issues.

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Section: Discussionmentioning

confidence: 99%

Intracranial suppuration complicating sinusitis among children: an epidemiological and clinical study

Piatt¹

2011

PED

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“…The management and prognosis depend on the location, pathology and the preoperative status of the patients. We have previously published our data regarding some focal intracranial infections in children (including subdural empyema, infratentorial subdural empyemas and infratentorial abscesses) [1,2,3]. In this report, we describe a comprehensive analysis of factors affecting recurrence and outcome of all the focal intracranial infections in children.…”

Section: Introductionmentioning

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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“…S. aureus infection can commonly occurr post-traumatically (6). SDE develops as a complication of bacterial meningitis resulting in significant morbidity and mortality, despite recent advances in neuroimaging, surgical techniques, and antibiotic therapy (7). …”

Section: Discussionmentioning

confidence: 99%

Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

Zhang

Chen

Xie

et al. 2017

Braz J Med Biol Res

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A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.

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Pediatric Supratentorial Subdural Empyemas: A Retrospective Analysis of 65 Cases

Cited by 37 publications

References 30 publications

Intracranial suppuration complicating sinusitis among children: an epidemiological and clinical study

Intracranial suppuration complicating sinusitis among children: an epidemiological and clinical study

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

Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

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