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Bilateral Decompressive Craniectomy for Subdural Empyema: A Case Report.
Georgi Krasimirov Georgiev1, Nurfet Alioski1, Tihomir Eftimov1
1Neurosurgery, Saint Anna University Hospital, Sofia, BGR.
Cureus
|April 27, 2026
Summary
Bilateral decompressive craniectomy is a rare but potentially life-saving procedure for severe subdural empyema (SDE) with uncontrollable intracranial pressure. This aggressive surgical approach may be considered in extreme cases when standard treatments fail to manage refractory intracranial hypertension.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Intracranial subdural empyema (SDE) is a severe brain infection with high neurological deterioration risk.
- Refractory intracranial hypertension in SDE poses significant management challenges despite advances in treatment.
- The role of decompressive craniectomy for infection-related intracranial hypertension is not well-established.

