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Omentum graft for intractable subdural empyema
Abstract:
A subdural empyema developed in a young man after craniotomy for evacuation of a hematoma in a sylvian fissure arachnoid cyst and the subdural space. Despite prolonged systemic and subdural antibiotic administration and a debridement of the subdural space, infection persisted, as evidenced by persistent fever, an elevated white blood cell count, and an extremely low cerebrospinal fluid glucose level. The infection was cured after a second debridement operation where microsurgically revascularized free omentum was used to obliterate the cyst and to cover the cerebral hemisphere in the craniotomy defect. The use of vascularized free omentum may prove useful in cases of refractory cranial wound infection and cerebrospinal fluid fistulas.
Insights
A young man developed a persistent subdural empyema after brain surgery. Microsurgically revascularized free omentum successfully treated the refractory cranial wound infection.
Area of Science:
- Neurosurgery
- Infectious Disease
Background:
- A patient developed a subdural empyema post-craniotomy for a sylvian fissure arachnoid cyst hematoma.
- Initial treatment with systemic and subdural antibiotics and debridement failed to resolve the infection.
Observation:
- Persistent fever, elevated white blood cell count, and low cerebrospinal fluid glucose indicated ongoing infection.
- The infection proved refractory to standard antibiotic and surgical interventions.
Findings:
- A second debridement operation utilizing microsurgically revascularized free omentum was performed.
- The omentum successfully obliterated the cyst and covered the cerebral hemisphere defect.
Implications:
- Vascularized free omentum can be an effective treatment for refractory cranial wound infections.
- This technique may also be beneficial for managing cerebrospinal fluid fistulas.