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Pediatric supratentorial subdural empyemas: a retrospective analysis of 65 cases

Anirban Deep Banerjee1, Paritosh Pandey, B Indira Devi

  • 1Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India. anirbandeepbanerjee@yahoo.com

Pediatric Neurosurgery
|February 18, 2009
PubMed

Insights

Pediatric subdural empyemas require prompt neurosurgical intervention. Early surgical drainage, preferably craniotomy, combined with antibiotics, leads to good outcomes in children with supratentorial SDEs.

Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Infectious Diseases

Background:

  • Intracranial subdural empyemas (SDEs) are common pediatric neurosurgical emergencies, particularly in developing nations.
  • Despite advances, SDEs carry significant morbidity and mortality, especially in children.
  • Supratentorial SDEs are the most frequent type, posing a critical challenge.

Purpose of the Study:

  • To retrospectively analyze the experience with operated pediatric supratentorial SDEs.
  • To evaluate clinical, radiological, and bacteriological factors influencing outcomes.
  • To assess the effectiveness of different surgical approaches and antibiotic therapies.

Main Methods:

  • Retrospective analysis of 65 pediatric patients (<18 years) with supratentorial SDEs treated between 1988 and 2006.
  • Case records reviewed for clinical presentation, etiology, surgical intervention (burr holes vs. craniotomy), complications, and outcomes.
  • Data analyzed regarding mortality, repeat surgeries, and long-term functional recovery (Glasgow Outcome Scale).

Main Results:

  • Otogenic, postmeningitic, and rhinogenic sources were common etiologies.
  • Craniotomy was associated with fewer repeat procedures and better outcomes compared to burr holes.
  • Mortality rate was 10.8%, with 88% of patients achieving good outcomes (GOS 4 or 5) at follow-up.

Conclusions:

  • Early surgical drainage, preferably craniotomy, is crucial for managing pediatric supratentorial SDEs.
  • Prompt identification and treatment, alongside source control and appropriate antibiotics, significantly improve patient outcomes.
  • Effective management of pediatric SDEs can reduce morbidity and mortality, leading to favorable long-term results.
Abstract

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