Subdural empyema: Clinical presentations and management options for an uncommon neurosurgical emergency in a developing country

Chikani, Mark C; Mezue, Wilfred C; Okorie, E; Mbachu, Chinyere; Ndubisi, C; Un, Chikani

doi:10.4103/njcp.njcp_340_16

Cited by 14 publications

(21 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[ 13 15 16 17 ] In a 10-year review of cases of intracranial SDE in an eastern Nigerian facility, the authors reported a 15.4% positive culture rate. [ 6 ] Our low positive yields from SDE cultures may be attributable to the large percentage of patients administered antibiotic therapy before presentation to tertiary care, a hypothesis that was also alluded to by Chikani et al [ 6 ]…”

Section: Discussionmentioning

confidence: 95%

Contemporary Management of Intracranial Subdural Empyema

Jolayemi

Bankole

Ojo

et al. 2022

Journal of West African College of Surgeons

View full text Add to dashboard Cite

Background: Intracranial subdural empyema (SDE) is a seemingly uncommon life-threatening ailment with varying presentations and outcomes. A variety of risk factors have been associated with predisposition to intracranial SDEs; however, they may be cryptogenic. There is an increased predilection for intracranial SDE in children and teenagers with paranasal sinusitis or middle ear infections. The clinical presentation is non-specific and thus a high index of suspicion is required. Neuroimaging is an invaluable diagnostic tool for early diagnosis and surgical intervention. There have been multiple proponents for either burr hole or craniotomy to treat intracranial SDEs; however, despite surgical intervention, adverse neurologic sequelae and even mortality still occur. Extended antibiotic therapy is mandatory and impacts significantly on patients’ outcomes. Objectives: This study describes the demographics, clinical presentation, and surgical outcomes in patients with intracranial SDEs over the study period. Design: This is a retrospective single-centre case series. Setting: This study takes place in a tertiary referral centre, university hospital. Materials and Methods: This was a retrospective review of patients presenting with intracranial SDEs over a 10-year period in a tertiary neurosurgical unit serving south-western Nigeria. Demographic, clinical, and radiologic data were retrieved from patient records. Results: Forty-nine patients presented with intracranial SDEs during the review period. These patients aged between 16 months and 75 years, most of whom were 20 years of age and below. The mean age was 21.37 ± 19.29 years with a median age of 15 years. There were 35 males and 14 females giving a male-to-female ratio of 2.5:1. The most common presentations were headache (73.5%), altered sensorium (55.1%), and seizures (38.8%). Forty patients (81.6%) had evacuation of SDE by burr hole and subdural washout. There was a significant post-op residual SDE in six patients. There were eight (16.3%) mortalities in this series. Forty-seven (95.9%) patients had sterile cultures of the subdural pus collection. Conclusion: Intracranial SDE affects mostly children and teenagers. Early diagnosis, emergent surgery, extended antibiotic therapy, and concurrent source control employing a multidisciplinary approach are essential in managing this condition. Burr hole and subdural washout help control the disease process, reduce operation time, and may yield outcomes similar to craniotomies, which are more invasive.

show abstract

Section: Discussionmentioning

confidence: 95%

Contemporary Management of Intracranial Subdural Empyema

Jolayemi

Bankole

Ojo

et al. 2022

Journal of West African College of Surgeons

View full text Add to dashboard Cite

show abstract

“…(5,2) En cuanto a la etiología infecciosa, coinciden los gérmenes identificados en nuestra revisión con los encontrados en los empiemas secundarios a intervenciones quirúrgicas, siendo el staphylococcus aureus el germen de mayor incidencia. (6,7) El lapso de aparición de los empiemas en nuestra revisión, cuando fueron secundarios a la evacuación de un HSD previo, fue de hasta 3 meses posterior a la cirugía, lo que no está descrito en la literatura revisada, con promedio de un mes posterior a ellas, lo que si se encontró descrito en otras publicaciones. Por tanto, debe considerarse en la aparición de este tipo de complicación relacionada con una cirugía previa de evacuación de un subdural (Figura 3), que puede tener una larga latencia en su debut en los pacientes.…”

Section: Discussionunclassified

“…En relación con lo anterior, una indicación adecuada para el uso de craneotomía serían aquellos casos con presencia de tabicaciones al interior de la colección (1) . Algunos trabajos mencionan que habría menor recidiva cuando se utiliza la craneotomía (7) , sin embargo, en nuestra revisión no se objetivó ninguna diferencia.…”

Section: Discussionunclassified

Empiema subdural y su relación con hematomas subdurales: experiencia local y revisión de la literatura

S.¹,

et al. 2022

Rev. chil. neuro-psiquiatr.

View full text Add to dashboard Cite

Subdural empyemas, both spontaneous or as a complication in the evolution of subdural hematomas, are an uncommon fact of which there are few publications in literature. In this review we analyze a retrospective serie of 15 cases operated in HUAP in a period of 15 years. In general we don't observed differences in the outcome using different surgical techniques, both in those treated by craniectomy as those treated by craniotomy. Also we don't observed differences in those treated with or without drainage. In the same way is clear that the optimal period of antibiotic treatment must be 3-4 weeks to fully cover them. None of the cases treated, needed reintervention.

show abstract

“… 9 , 25 However, spinal puncture is not advised for the evaluation and diagnosis of SDE, because it can be life threatening to patients with elevated ICP and empyemas, thereby leading to mass effect. 8 , 17 , 26 The mainstay of SDE treatment consists of combined empirical antimicrobial therapy and surgical intervention. 2 , 10 , 22 , 25 , 29 , 32 , 33 Patients are rarely managed solely with antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment consists of burr hole aspiration or craniotomy for drainage and debridement of the SDE. 18 , 24 , 26 It is recommended that the collection of pus obtained upon evacuation undergo laboratory evaluation for both aerobic and anaerobic cultures. 13 , 25 , 27 , 32 Antibiotic therapy should be adjusted to account for reported microorganisms from culture results.…”

Section: Discussionmentioning

confidence: 99%

Unusual intracranial suppuration: illustrative cases

Pradhan

Rutayisire

Munyemana

et al. 2021

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

BACKGROUND Intracranial suppuration (ICS) is a rare complication that can arise from various disease processes and is composed of brain abscess, extradural empyema, and subdural empyema. Although significant progress has been achieved with antibiotics, neuroimaging, and neurosurgical technique, ICS remains a serious neurosurgical emergency. An uncommon presentation of ICS is sterile ICS, which has yet to be fully elucidated by clinicians. The authors present 2 cases of unusual sterile ICS: a sterile subdural empyema and a sterile brain abscess. OBSERVATIONS Both patients underwent surgical treatment consisting of craniotomy to evacuate the pus collection. The blood cultures from both the patients, the collected empyema, and the thick capsule from the brain abscess were sterile. However, the necrotic brain tissue surrounding the abscess contained inflammatory cells. The authors’ review of the literature emphasizes the rarity of sterile ICS and substantiates the necessity for additional studies to explore this field. LESSONS Sterile ICS is a disease entity that warrants further investigation to determine appropriate treatment to improve patient outcomes. This study highlights the paucity of data available regarding sterile ICS and supports the need for future studies to uncover the etiology of sterile ICS to better guide management of this condition.

show abstract

Subdural empyema: Clinical presentations and management options for an uncommon neurosurgical emergency in a developing country

Abstract: BAAD is the near approximated option to standard craniotomy management in a limited resource facility and it has a very good clinical outcome. However, more studies are required to draw the final conclusion.

Cited by 14 publications

References 2 publications

Contemporary Management of Intracranial Subdural Empyema

Contemporary Management of Intracranial Subdural Empyema

Empiema subdural y su relación con hematomas subdurales: experiencia local y revisión de la literatura

Unusual intracranial suppuration: illustrative cases

Contact Info

Product

Resources

About