Omentum graft for intractable subdural empyema

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.