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Subdural empyemas in children
1Pediatric Neurosurgery, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City.
Insights
Subdural empyema treatment in children can be successful with prompt surgical intervention and antibiotics. Burr hole drainage is often sufficient, leading to no deaths and good developmental outcomes in this study.
Area of Science:
- Neurosurgery
- Pediatric Infectious Diseases
Background:
- Subdural empyema is a life-threatening neurosurgical emergency.
- High mortality rates (30-40%) are associated with delayed diagnosis and management.
- Craniotomy and aggressive medical therapy are traditionally recommended.
Purpose of the Study:
- To evaluate the efficacy of less invasive surgical techniques for pediatric subdural empyema.
- To assess outcomes including mortality, morbidity, and neurodevelopmental status.
Main Methods:
- Retrospective review of 8 children (2 months to 13 years) treated between 1978-1986.
- Surgical interventions included burr hole and catheter drainage, craniotomy, and subdural taps.
- All patients received antibiotic therapy.
Main Results:
- No deaths occurred in the series.
- Five children underwent burr hole and catheter drainage; one required craniotomy.
- Three infants received subdural taps via the anterior fontanel.
- Five children had no developmental or intellectual deficits at an average 29-month follow-up.
Conclusions:
- Burr hole and catheter drainage is a sufficient treatment for most pediatric subdural empyemas.
- Early diagnosis, antibiotics, and timely surgical intervention significantly reduce morbidity and mortality.
- Less invasive surgical approaches may be effective alternatives to craniotomy.
Abstract:
Subdural empyema is a neurosurgical emergency which is rapidly fatal if not recognized and managed promptly. Most series report a 30-40% mortality, and recommend a craniotomy along with aggressive medical therapy. Between 1978 and 1986, 8 children (2 months to 13 years) with subdural empyemas were diagnosed and treated at our institution, and form the basis for this study. Burr hole and catheter drainage was the treatment of choice in 5 children, while craniotomy was required in 1 case of sinusitis with osteomyelitis. Three infants received multiple subdural taps via the anterior fontanel. All patients responded to surgical intervention and antibiotic therapy. The average follow-up period was 29 months, and 5 children had no developmental delay, decrease in school performance, or impairment of intellectual function. There were no deaths in our series. Although the surgical management of subdural empyemas remains controversial, it appears that burr hole and catheter drainage is sufficient in most cases. With earlier diagnosis, aggressive antibiotic therapy, and timely surgical intervention, the morbidity and mortality of subdural empyemas have significantly diminished in recent years.