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Falcotentorial subdural empyema: analysis of 10 cases
Pravin Shashikant Salunke1, Vinod Malik, Priyamvadha Kovai
1Department of Neurosurgery, PGIMER, Chandigarh 160012, India. drpravin_salunke@yahoo.co.uk
Acta Neurochirurgica
|May 28, 2010
Summary
Falcotentorial subdural empyema is rare but treatable. Prompt surgical intervention and antibiotics lead to good patient outcomes.
Area of Science:
- Neurosurgery
- Infectious Diseases
Background:
- Subdural empyema (SE) is a rare but serious infection of the space between the dura mater and the arachnoid mater.
- Falcotentorial subdural empyema (FTSE) specifically involves the parafalcine region and the superior or inferior surfaces of the tentorium cerebelli, representing an even rarer subset of SE.
Observation:
- This study reviewed 10 cases of FTSE managed between 2004 and 2010.
- Patients presented with indolent symptoms including fever, raised intracranial pressure, falx syndrome, and seizures.
- Chronic suppurative otitis media was the source in 50% of cases; others were presumed hematogenous.
Findings:
- Diagnosis was confirmed via radiology.
- Management involved a combination of 6-week antibiotic therapy and surgery (craniotomy/craniectomy with pus evacuation) in 80% of patients.
- Surgical technique focused on excising the dural layer adherent to the falx/tent, leaving the pia-arachnoid layer intact.
Implications:
- FTSE exhibits a more indolent presentation compared to convexity SE, likely due to anatomical constraints.
- Aggressive surgical management, including wide opening of the empyema cavity and adjuvant antibiotic therapy, is crucial for favorable outcomes.
- Despite its rarity, FTSE can be effectively managed with a good prognosis, as evidenced by a single mortality and good outcomes in survivors.
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