Two surgical methods used in 90 patients with intracranial subdural empyema

Continuous Subdural Irrigation and Drainage for Intracranial Subdural Empyema in a 92-Year-Old Woman

“…Certain unfavorable prognostic factors have also been identifi ed in ISDE, including (1) encephalopathy or coma at the time of presentation; (2) elderly patients or young patients below 10 years; (3) delay in starting antibiotics; and (4) sterile cultures [3] . Many ISDE are associated with severe cerebral edema, and in these patients, a wide open cranial surgery is necessary for survival [1] . Complete elimination of subdural empyema decreases the mass eff ect and allows for better antibiotic penetration [1] .…”

“…Many ISDE are associated with severe cerebral edema, and in these patients, a wide open cranial surgery is necessary for survival [1] . Complete elimination of subdural empyema decreases the mass eff ect and allows for better antibiotic penetration [1] . Nathoo et al [4] found that neurological improvement and the outcome of patients with ISDE was closely related to a wide open cranial surgery.…”

“…Intracranial subdural empyema (ISDE) is a lifethreatening intracranial infection and accounts for 15 -25 % of the cases of pyogenic intracranial infection [1] . Early and precise detection, timely surgery, and appropriate antibiotic therapy are the keys to a more favorable clinical outcome [2] .…”

“…Treatment is aimed at complete evacuation of the empyema and eradication of the source of infection [3] . Although the most appropriate surgical method for the treatment of ISDE remains controversial, many recent studies have found that a wide open cranial approach is a better surgical method for the treatment of ISDE as compared to procedures involving drainage through burr holes, since it results in improved clinical status of patients, more complete clearance of the empyema, and reduced incidence of reoperation [1,4,5] . However, in the cases of elderly patients or patients with poor health, doctors hesitate to perform open cranial surgery under general anesthesia; thus, the choice of the appropriate surgical method is fraught with many limitations.…”

Neuro-Intensive Care of Patients with Acute CNS Infections

“…The goals of surgical therapy for cranial SE is to decompress the brain and evacuate the empyema. A recent study showed improved outcomes in patients with craniotomy [94], but the specific approach (burr hole vs craniotomy) to achieve decompression and evacuation is controversial [92]. Once diagnostic material is obtained for cultures, empiric antibiotic therapy should be initiated based on the Gram stain and the underlying risk for infection.…”