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[Subdural empyema. Present possibilities of diagnosis and therapy]
Abstract:
The authors give an account of their experience with the diagnosis and treatment of subdural empyema. In 1953-1991 in the neurosurgical department in Olomouc a total of five patients with this diagnosis were treated. None of them died. In all patients before operation symptoms of meningeal irritation, fever and in four patients a focal neurological symptomatology was observed. The authors reached the conclusion that the best surgical approach is craniotomy or craniectomy which should be preferred to minor surgical operations. Treatment of the primary inflammatory focus leading to the development of subdural empyema must be part of the intracranial operation. Regular postoperative follow-up of the patient by means of CT makes it possible to detect in time relapses and leads to early surgical operation. The authors mention experience focused on possible errors in the CT diagnosis. The creation of the picture of subdural collection precedes oedema of the hemisphere with a shift of the structures in the median line. The subdural collection occurs in the subsequent stage of development of the disease.
Insights
Subdural empyema treatment is most effective with craniotomy or craniectomy. Early CT diagnosis and surgical intervention for the primary focus improve outcomes for this serious brain infection.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Radiology
Background:
- Subdural empyema is a serious intracranial infection requiring prompt diagnosis and treatment.
- This study reviews a single neurosurgical center's experience with subdural empyema over several decades.
Observation:
- Five patients with subdural empyema were treated between 1953 and 1991.
- Common pre-operative symptoms included meningeal irritation, fever, and focal neurological deficits.
- Computed tomography (CT) is crucial for diagnosis, though potential diagnostic errors were noted.
Findings:
- Craniotomy or craniectomy were identified as the optimal surgical approaches, superior to less invasive procedures.
- Integrated treatment of the primary inflammatory source during intracranial surgery is essential.
- Postoperative CT surveillance aids in timely detection of recurrences, enabling early re-intervention.
Implications:
- Aggressive surgical management and comprehensive treatment of the underlying cause are vital for favorable outcomes in subdural empyema.
- Advanced imaging techniques like CT are indispensable for diagnosis and monitoring, despite potential pitfalls.
- Effective management strategies can lead to successful recovery without mortality, as demonstrated in this case series.