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Treatment of subdural empyema by burr hole
H E AK1, U Ozkan, C Devecioglu
1Department of Neurosurgery, Dicle University Medical Faculty, Diyarbakir, Turkey.
Abstract:
Subdural empyema, a collection of pus in the space between the dura and arachnoid, is a rare type of intracranial infection. We report on 23 patients, aged 8 months to 70 years, with subdural empyema who were treated in our clinic between 1989 and 1994. The sources of subdural empyemas were meningitis in five patients, middle ear in five, trauma in four, paranasal sinus in three, complications of surgery and subdural tap in four, and unknown in two patients. The common presentations were headache, focal neurologic deficit, fever, vomiting, seizures, and neck stiffness. Diagnosis was achieved by computerized tomography and neurologic examinations in all cases. Treatment was effected by burr hole or small craniotomy with catheter drainage, and antibiotics were administered to all patients. The mortality rate was 8.7%; the remaining patients made a good recovery without sequelae. We therefore recommend burr hole with catheter drainage plus antibiotics as a method of treating subdural empyema.
Insights
Subdural empyema, a rare intracranial infection, is effectively treated with catheter drainage and antibiotics, leading to good recovery in most patients. This approach offers a low mortality rate for this serious brain infection.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Subdural empyema is a rare but serious intracranial infection.
- It involves pus collection between the dura and arachnoid layers of the brain.
- Prompt diagnosis and treatment are crucial for patient outcomes.
Purpose of the Study:
- To report on the clinical characteristics, treatment, and outcomes of patients with subdural empyema.
- To evaluate the efficacy of surgical drainage and antibiotic therapy.
- To recommend an optimal treatment strategy.
Main Methods:
- Retrospective case series of 23 patients treated between 1989 and 1994.
- Diagnosis confirmed by computerized tomography (CT) scans and neurological examinations.
- Treatment involved burr hole or craniotomy with catheter drainage and antibiotics.
Main Results:
- Common causes included meningitis, middle ear infections, trauma, and sinus infections.
- Presenting symptoms included headache, fever, seizures, and neurological deficits.
- An 8.7% mortality rate was observed, with most patients achieving good recovery without sequelae.
Conclusions:
- Burr hole with catheter drainage and antibiotics is a recommended treatment for subdural empyema.
- This method demonstrates a low mortality rate and high recovery success.
- Effective management requires timely diagnosis and multi-modal treatment.