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[Subdural empyema in children: therapeutic strategy. Five cases]
O Klein1, S Freppel, H Schuhmacher
1Département de Neurochirurgie, Hôpital Central, CHU, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy Cedex. o.klein@chu-nancy.fr
Neuro-Chirurgie
|July 15, 2006
Summary
Subdural empyema (SDE) in pediatric patients requires aggressive surgical intervention, including large craniotomies, and tailored antibiotic therapy. This approach, combined with diligent follow-up, leads to favorable outcomes and prevents long-term sequelae.
Area of Science:
- Neurosurgery
- Pediatric Infectious Diseases
- Critical Care Medicine
Background:
- Subdural empyema (SDE) is a serious intracranial infection requiring prompt management.
- Optimal surgical and antibiotic strategies for pediatric SDE remain critical areas of neurosurgical focus.
Observation:
- A retrospective review of five pediatric and young adult cases of SDE treated surgically.
- Patients ranged from 3 months to 18 years; SDE post-neurosurgery cases were excluded.
- Surgical interventions included burr hole evacuation or craniotomy, with antibiotic therapy averaging 52 days.
Findings:
- Aggressive surgical treatment, particularly large craniotomies for thorough pus and membrane removal, is advocated.
- Successful outcomes were achieved in all five patients, with no reported sequelae at a median 22-month follow-up.
- Microorganisms identified included Streptococcus intermedius, Streptococcus pneumoniae, and Escherichia coli; one case had no identified organism.
Implications:
- Advocacy for aggressive surgical management of pediatric SDE, emphasizing complete debridement and appropriate antibiotic therapy.
- The necessity of eradicating the infection source and the potential need for re-operation.
- Close patient follow-up is crucial due to the significant risk of SDE recurrence.
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