Burr hole evacuation for infratentorial subdural empyema
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Updated: May 5, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Ridvan Alimehmeti1, Arsen Seferi, Gentian Stroni
1Ridvan Alimehmeti, Arsen Seferi, Kliti Pilika, Mentor Petrela, Service of Neurosurgery, University Hospital Centre "Mother Theresa", 270 Tirana, Albania.
Abstract:
Infratentorial empyema is a life threatening condition and constitutes a neurosurgical emergency. Purulent mastoiditis and medial otitis is the most common origin and a thorough eradication of the purulent foci is mandatory. Decompression craniectomy has been primarily advised in the literature as the gold standard of the surgical treatment but burr hole evacuation when there the lack of cerebellar edema is less invasive and deemed equally efficient in the few reported cases. This is the report of a seventeen year old female who presented in a comatose state due to infratentorial empyema with acute hydrocephalus and who improved immediately after burr hole evacuation. Details of the surgical procedures are given. Mastoidectomy was completed, with the patient under combined antibiotherapy. She leads a normal life now, more than six years after surgery.
Insights
Infratentorial empyema, a critical neurosurgical emergency, can be effectively treated with burr hole evacuation, especially when cerebellar edema is absent. This less invasive approach offers a promising alternative to decompressive craniectomy for patients with purulent mastoiditis.
Area of Science:
- Neurosurgery
- Infectious Diseases
Background:
- Infratentorial empyema is a life-threatening neurosurgical emergency.
- Purulent mastoiditis and medial otitis are common origins requiring complete eradication of infection.
Observation:
- A 17-year-old female presented in a comatose state with infratentorial empyema and acute hydrocephalus.
- Surgical intervention involved burr hole evacuation and mastoidectomy under combined antibiotic therapy.
Findings:
- The patient showed immediate improvement after burr hole evacuation.
- Long-term follow-up exceeding six years shows the patient leading a normal life.
Implications:
- Burr hole evacuation is a less invasive and potentially equally efficient alternative to decompressive craniectomy for infratentorial empyema without cerebellar edema.
- This case highlights the successful management of a severe neurosurgical condition with a minimally invasive technique.
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