Epidural Empyema Research Articles

Thoracic spinal epidural empyema in a cat

A 2-month-old male domestic shorthair cat was referred to a private veterinary clinic with a history of dyspnea and inappetence. At the clinical examination, the cat was in poor body condition, with hyperthermia and abdominal distension. No major abnormalities were observed in the thoracic radiographs or abdominal ultrasound. A complete blood count revealed leukocytosis with neutrophilia. Although no clinical diagnosis was made, the cat received support therapy, but went into cardiac arrest and died. The cat was submitted for necropsy and the main gross finding was two white nodules on the ventral surface of the thoracic vertebrae (from T1 to T4). At the cut surface, the nodules were friable and filled with yellow exudate. The epidural space of the thoracic region was filled with yellowish viscous material. Histologically, the vertebrae were partially replaced by abscess formation characterized by a necrotic center with degenerate neutrophils, surrounded by fibrous connective tissue. The epidural space was filled with degenerate neutrophils, necrotic debris, fibrin, and intralesional colonies of gram-negative short rod-shaped to coccobacillary bacteria. Bacteriologic culture yielded Pasteurella multocida. This paper describes the gross, histological, and bacteriological features of a rare case of spinal epidural empyema caused by Pasteurella multocida in a cat.

Spontaneous empyema and brain abscess in an intensive care population: clinical presentation, microbiology, and factors associated with outcome

BackgroundData on critically ill patients with spontaneous empyema or brain abscess are limited. The aim was to evaluate clinical presentations, factors, and microbiological findings associated with the outcome in patients treated in a Neurocritical Care Unit.MethodsIn this retrospective study, we analyzed 45 out of 101 screened patients with spontaneous epidural or subdural empyema and/or brain abscess treated at a tertiary care center between January 2012 and December 2019. Patients with postoperative infections or spinal abscess were excluded. Medical records were reviewed for baseline characteristics, origin of infection, laboratory and microbiology findings, and treatment characteristics. The outcome was determined using the Glasgow outcome scale extended (GOSE).ResultsFavorable outcome (GOSE 5–8) was achieved in 38 of 45 patients (84%). Four patients died (9%), three remained severely disabled (7%). Unfavorable outcome was associated with a decreased level of consciousness at admission (Glasgow coma scale < 9) (43% versus 3%; p = 0.009), need of vasopressors (71% versus 11%; p = 0.002), sepsis (43% versus 8%; p = 0.013), higher age (65.1 ± 15.7 versus 46.9 ± 17.5 years; p = 0.014), shorter time between symptoms onset and ICU admission (5 ± 2.4 days versus 11.6 ± 16.8 days; p = 0.013), and higher median C-reactive protein (CRP) serum levels (206 mg/l, range 15–259 mg/l versus 17.5 mg/l, range 3.3–72.7 mg/l; p = 0.036). With antibiotics adapted according to culture sensitivities in the first 2 weeks, neuroimaging revealed a progression of empyema or abscess in 45% of the cases.ConclusionFavorable outcome can be achieved in a considerable proportion of an intensive care population with spontaneous empyema or brain abscess. Sepsis and more frequent need for vasopressors, associated with unfavorable outcome, indicate a fulminant course of a not only cerebral but systemic infection. Change of antibiotic therapy according to microbiological findings in the first 2 weeks should be exercised with great caution.

Oral sequential therapy in the treatment of post-surgical epidural abscess and subdural empyema.

The management of post-surgical subdural empyema and subdural abscess is not standardised. The objective was to analyse the efficacy and safety of oral sequential therapy (OST). Retrospective observational study in a tertiary hospital in Vigo (Spain). We included adult patients with subdural abscess or epidural empyema with microbiological isolation. Clinical and demographic variables, isolated microorganisms and treatment regimens were included, as well as mortality and adverse effects during the follow-up period. Thirty patients were reviewed, two died due to causes other than infection. Six-month recurrence rate was 2/28 and all other patients (26/28) had clinical cure at the end of the treatment. The commonest isolated microorganisms were Gram-positive, especially Staphylococcus aureus. The most widely used oral antibiotic was trimethoprim-sulfamethoxazole (80%). No side effects related to oral treatment were observed. After adequate source control, OST can be a safe practice in the management of post-surgical epidural abscess and subdural empyema.

Spontaneous Spinal Epidural and Subdural Empyema Causing Cauda Equina Syndrome: A Rare Case Report and Review of Literature

Spontaneous Spinal Epidural and Subdural Empyema Causing Cauda Equina Syndrome: A Rare Case Report and Review of Literature

Multicenter Study of Clinical Presentation, Treatment, and Outcome in 41 Dogs With Spinal Epidural Empyema

There is limited information on canine spinal epidural empyema (SEE). The aim of this multicenter retrospective study is to describe the clinical presentation and outcome of dogs undergoing spinal surgery or conservative management for SEE. Forty-one dogs met the inclusion criteria; the SEE was treated surgically in 17 dogs and conservatively in 24 dogs. Two dogs underwent spinal surgery after failure of conservative management, meaning that 19 dogs in total had spinal surgery. Long-term (i.e., >6 months) follow-up was available in 35 dogs (19 conservatively treated and 16 surgically treated dogs). Recovery to a functional pet status was achieved in 15/19 (78.9%) conservatively treated and 12/16 (75%) surgically treated dogs. There was no significant difference (p = 1.000) in long-term outcome between conservatively and surgically treated dogs (78.9 and 75%, respectively). However, significantly more surgically treated dogs were non-ambulatory at presentation (9/17 vs. 5/24, p = 0.048) compared with conservatively treated dogs. This study suggests that conservative treatment may be appropriate for dogs with SEE that are ambulatory at presentation and that surgically treated dogs generally have good outcomes. Age may be a negative prognostic indicator as dogs with poor long-term outcomes were significantly older than dogs with a good long-term outcome (p = 0.048). A larger prospective randomized study may provide further insight on treatment and outcome of SEE in dogs.

Risk Factors and Surgical Treatment Options for Intracranial Infections.

To present our experience on intracranial infections, and to determine the possible locations as well as the risk factors for surgical treatment. Over 13 years, 103 patients with intracranial infection underwent surgical evacuation. Seventy-one (68.9%) patients were men, and the mean age was 38.57 years. For intracranial infections, direct and indirect microbiological identification methods were used. The clinical and radiological data of patients were retrospectively analyzed and compared statistically based on the type of infection, location, history of previous surgery, comorbid diseases, and demographic features of the patients. Forty-six (44.7%) patients had intraparenchymal abscess, 25 (24.3%) had subdural empyema, and 32 (31.0%) had epidural empyema. Emergent surgical evacuation was performed in 60 (58.25%) patients. Microbiological agents were not isolated in 26 (25%) patients, while multiple microorganisms were isolated in 17 (16.5%) patients. Intraparenchymal abscesses are more common in the frontal lobe and cerebellum, while subdural empyemas are located more frequently in the frontoparietal region. There was no significant difference between intracranial infection and age, gender, history of surgery, and preoperative antibiotic use. However, a statistically significant relationship between intracranial infection, history of previous surgery, and the patient?s comorbid disease was found. Specifically, intraparenchymal abscesses were more frequently detected in immunocompromised patients, and subdural empyemas were common in patients with previous tumor surgery. Brain abscesses commonly develop in the frontal lobe and cerebellum. Patients who underwent previous cranial surgery and patients with comorbid diseases are more prone to intracranial infections. Large abscesses with significant edema are best candidates for emergent surgical evacuation.

An in Depth Look Into Intracranial Abscesses and Empyemas: a Ten-year Experience in a Single Institute.

Background:As the incidence of intracranial infections increase due to diagnostic procedures improvement, more real-life data is needed to reach a more solid informed management approach.Objective:This study aims to describe and analyse clinical features of intracranial abscesses patients treated at a tertiary hospital in North Jordan during a 10-year period.Methods:We retrospectively identified 37 patients treated at King Abdullah University Hospital (KAUH) from 2011 to 2020 in Irbid, North Jordan. Treatment consisted of either aspiration, open craniotomy excision (OCE) or conservative therapy. Extracted variables included demographic data such (age, gender), clinical presentation, lab findings, radiological findings as well as management plan. Retrieved data was compared between the patients who underwent a single operation and those who underwent reoperation after the initial procedure.Results:Thirty-seven patients with 55 intracerebral abscesses were identified, 29 of whom had intraparenchymal brain abscesses, 4 patients had epidural empyema, and 4 had subdural empyema. The mean age was 28.8 (± 20.7) years, with a male predominance (78.4%). Sixteen patients underwent open craniotomy excision (OCE), 14 patients were treated by aspiration and 7 patients were treated conservatively. When comparing the single operation and the reoperation groups, there was no statistically significant difference across variables.Conclusion:Our study presents valuable insight from a tertiary hospital in north Jordan on intracranial abscesses and empyemas. Our findings confirm that good recovery can be established after aspiration or OCE in the majority of patients. Similar results were obtained when comparing the SOP and the ROP groups.

264. A 20-year Study of Intracranial Pyogenic Complications of Sinusitis in Children

Abstract Background Intracranial pyogenic complications of sinusitis in children are relatively uncommon but can lead to serious sequelae. The objective of this study was to characterize the clinical, epidemiologic and microbiologic characteristics of children with such complications over a 20-year period (2000- 2019). Methods Single-center retrospective chart review. Cases were identified based on International Classification of Diseases (ICD)-10 diagnostic codes (intracranial abscess or granuloma, extradural and subdural abscess, Pott’s puffy tumor, acute or chronic sinusitis) and by reviewing all microbiological samples of intracranial pus, tissue or fluid. Results 108 cases of clinically and/or radiologically diagnosed sinusitis were included after review of 1591 charts. The majority were adolescents (median age 12, IQR 9-14); 72 were male (67%). The most common presenting symptoms were fever (84%), headache (87%) and symptoms of upper respiratory tract infection (57%). Median symptom duration was 10 days (IQR 5-21) and 55 cases (51%) received oral antibiotics prior to admission. The most frequent complications were epidural empyema (n=50, 46%), subdural empyema (n=46, 43%) and Pott’s puffy tumor (n= 31, 29%). 50% (n=54) underwent neurosurgery, of which 20% (n=11) required multiple craniectomies. 38% (n=41) underwent otolaryngological surgery. Microbiological data from sterile specimens demonstrated single organisms in 36 cases (59%) and polymicrobial growth in 25 cases (41%). The most frequently identified pathogens were Streptococcus anginosus (n=40, 66%) followed by Fusobacterium species (n=10, 16%) and Prevotella species (n=10,16%). Most cases were treated with combination antibiotic therapy (n=68, 63%) and 14% (n=15) with a carbapenem. The median duration of intravenous antibiotic therapy was 51 days (IQR 42-80). One child died and 23% (n=25) suffered neurological sequelae (median follow-up 344 days). 48 cases (44%) occurred between 2014-2019. Conclusion Intracranial complications of sinusitis continue to cause significant morbidity in children. The predominant causative pathogen was Streptococcus anginosus. Polymicrobial infections are common, confirming the need for prolonged broad-spectrum antibiotic treatment. Disclosures Sharon Cushing, MD, MSc, FRCSC, Cochlear Corporation (Research Grant or Support)Cochlear Corporation (Speaker’s Bureau)Interacoustics (Speaker’s Bureau)Plural publishing (Other Financial or Material Support, Royalties: editor: manual of pediatric balance disorders)

Cerebral epidural empyema due to Bartonella henselae: a case report

BackgroundCat scratch disease frequently involves a benign, self-limited disease. Neurological forms associated with Bartonella henselae are uncommon, consisting mostly in neuroretinitis, encephalitis and meningitis. Cerebral epidural empyema has never described.Case presentationAn adult patient was hospitalized for isolated headaches. Magnetic Resonance Imaging (MRI) identified typical features of cerebral epidural empyema. The diagnosis of B. henselae was performed incidentally by 16S rDNA gene sequencing on the abscess fluid, and confirmed by specific qPCR. We report here the first case, to our knowledge, of cerebral epidural empyema associated with B. henselae. Further follow-up visits allowed identifying frequent cat scratches on the scalp as the presumptive source of infection.ConclusionsThis case report alerts about such atypical clinical presentation, which requires an extensive clinical investigation. It also emphasizes on the usefulness of additional molecular diagnosis techniques in such CNS infection cases.

Repeated intracranial empyema following cranioplasty in a patient with atopic dermatitis: a case report

BackgroundAtopic dermatitis is a chronic inflammatory skin disease associated with pruritus. Skin affected by atopic dermatitis not only shows a high percentage of Staphylococcus aureus colonization, but corneal barrier dysfunction is also known to occur. It is considered a risk factor for bacterial infections in various areas of the body. However, the relationship between atopic dermatitis and bacterial infection following neurological surgery has not yet been reported. Here, we present a case of atopic dermatitis in which the surgical site became infected twice and finally resolved only after the atopic dermatitis was treated.Case presentationA 50-year-old Japanese woman with atopic dermatitis underwent cerebral aneurysm clipping to prevent impending rupture. Postoperatively, she developed repeated epidural empyema following titanium cranioplasty. As a result of atopic dermatitis treatment with oral antiallergy medicines and external heparinoids, postoperative infection was suppressed by using an absorbable plastic plate for cranioplasty. The patient’s postoperative course was uneventful for 16 months.ConclusionsAtopic dermatitis is likely to cause surgical-site infection in neurosurgical procedures, and the use of a metal implant could promote the development of surgical-site infection in patients with dermatitis.

A Case Report of Mycetoma and Cranial Osteomyelitis by Nocardia nova

AbstractMycetoma is a chronic, localized, slowly progressive, granulomatous infection of the skin that may progress to subcutaneous tissue, muscle and bone. It is an infrequent manifestation of Nocardia infection that predominantly occurs on the lower extremities.A previously healthy, 17-year-old boy presented to us with a 3-month history of scalp abscesses. On physical examination he had numerous, large left parietal and occipital inflammatory nodules on the scalp covered by alopecic skin and several sinuses discharging a purulent and serosanguinous material. He underwent a CT-scan and an MRI of the skull that revealed signs of cranial osteomyelitis and epidural empyema. Polymerase chain reaction assay of the purulent exudate was performed and identified Nocardia nova. The patient was discharged from the hospital after 8 weeks of antibiotherapy with meropenem and TMP-SMX with clinical, laboratorial and imaging improvement. He completed 12 months of outpatient oral therapy with TMP-SMX, after which cranial CT-scan showed a significant reduction of soft tissue thickening and bone reconstitution, with no relapses after stopping the treatment.The best antibiotic regimen and length of treatment are not established for the management of nocardiosis. This is an unusual and severe presentation of infection by Nocardia nova with extent to the bone and epidural space, with full recovery under standard antibiotic therapy. This case shows that a good outcome may be achieved with prolonged antimicrobial treatment in an immunocompetent patient.

Odontogen frontoparial epidural and subdural empyema complicated with frontal intracerebral abscess and Covid

Introduction: Cerebral infections (frontoparietal extradural and subdural empyema) following a dental abscess and multiple sinusitis is a rare and potentially devastating entity even in the era of modern diagnosis and treatment.&#x0D; Case presentation: We present a patient with parietal epidural and subdural empyema and intracerebral frontal abscess, sinusitis and dental abscess, chronic consumer of alcohol and with neglected diabetes mellitus. He was initially diagnosed with encapsulated hematoma and sinusitis. The pus obtained at the intervention was certified by our laboratory as sterile with the consequent difficulty in antibiotic treatment and who induced a longer antibiotic treatment, a second surgical intervention for an encapsulated frontal abscess, a longer hospitalisation and favoured contamination with Covid 19. Despite these, the patient had a finally good evolution.&#x0D; Conclusions: A frontoparietal extradural and subdural empyema and an intracerebral frontal abscess produced by a dental abscess and sinusitis is a rare and potentially lethal complication. The multidisciplinary approach between radiologist, neurosurgeon, otolaryngologist, dentist, microbiologists is mandatory for a proper diagnosis and treatment of these pathologies.

A Rare Case of Extensive Spondylodiscitis

A 71-year-old man with a history of diabetes mellitus was admitted to our hospital with a 2-week history of fever and low back pain. Physical examination showed fever (38.1°C), painful palpation of the lower lumbar vertebrae and right lower limb paresis. Blood examination revealed an increased white blood cell count (16700x109/L) and C- reactive protein (22,39 mg/dL). Magnetic resonance imaging showed extensive spondylodiscitis, with osteomyelitis of the L5, S1 and S2 vertebral bodies, discitis, large epidural empyema, paraspinal and epidural abscesses. Patient was submitted to surgical treatment and was started on empirical antimicrobial therapy. Blood and intraoperative cultures were negative. Brucellosis and tuberculosis testing was negative. A 10- week course of antimicrobial therapy was performed with progressive decline of acute-phase reactants, reduction in pain and improvement of the neurological deficit. At 1-year follow up with light residual lower back pain and no neurological deficit.

Hyperbaric oxygen for intracranial abscess

The term “intracranial abscess” (ICA) includes cerebral abscess, subdural empyema, and epidural empyema, which share many diagnostic and therapeutic similarities and, frequently, very similar etiologies. Infection may occur and spread from a contiguous infection such as sinusitis, otitis, mastoiditis, or dental infection; hematogenous seeding; or cranial trauma. In view of the high morbidity and mortality of ICA and the fact that hyperbaric oxygen therapy (HBO2) is relatively non-invasive and carries a low complication rate, the risk-benefit ratio favors adjunct use of HBO2 therapy in selected patients with intracranial abscess.

ROLE OF IMAGING IN DIAGNOSIS OF INTRACRANIAL INFECTIONS- LITERATURE REVIEW

Neuroimaging performs an essential position in the analysis and diagnostic choice making in infectious illnesses of the world. The overview summarizes imaging findings and latest advances in the diagnosis of pyogenic brain abscess, ventriculitis, viral diseases which includes distinguished and emerging viruses, and opportunistic infections. For each circumstance, the ensuing therapeutic steps are presented. In instances of typical meningitis, cranial computed tomography (CT) seems to be enough for clinical control to exclude acute cerebral edema, hydrocephalus, and pathology involving the base of the skull. Magnetic resonance imaging (MRI) is advanced in depicting complications like subdural and epidural empyema and vasculitic complications considerably on FLAIR (fluid-attenuated inversion healing)-weighted pics. The more recent technique of diffusion-weighted imaging (DWI) suggests early parenchymal headaches of meningitis in advance and with greater readability and is of assist in differentiation of pyogenic abscess (PA) from ring enhancing lesions of other etiology. Proton magnetic resonance spectroscopy (PMRS) seems to produce unique top patterns in instances of abscess. The presence of lactate cytosolic amino acids and absence of choline appears to signify PA. Additionally in instances of suspected opportunistic infection because of toxoplasma DWI can be of very helpful inside the differentiation from lymphoma, showing no limit of water diffusion. In patients with herpes simplex and extra exceptional viruses like West Nile and Murray Valley virus, DWI lets in advance lesion detection and better therapeutic intervention with virustatic tablets.

Immediate replacement of bone flap after craniotomy for empyema in children.

Optimal management of the bone flap after craniotomy for intracranial infection has not been well defined in the pediatric population. This study reviewed the outcomes of a single Canadian center where immediate replacement of the bone flap was standard practice. This is a retrospective study of all patients who underwent craniotomies for evacuation of epidural or subdural empyema at a single center from 1982 to 2018. Patients were identified using the prospective surgical database maintained by the Division of Pediatric Neurosurgery at BC Children's Hospital. Primary outcome was treatment failure, defined as reoperation at the site of initial surgery for removal of an infected bone flap or repeat drainage of empyema under the replaced bone flap. Secondary outcome was any reoperation for recurrent infection at any site. Twenty-four patients met the inclusion criteria with a minimum of 3-month follow-up from the index intervention. Treatment failure occurred in four patients (17%), all of whom required repeat surgery for further drainage of pus underlying the bone flap. Mean time to repeat surgery was 13 days. Any reoperation for recurrent infection at any site occurred in three patients. Seven out of 24 patients required a second surgery to evacuate empyema (29.2%). Age, sex, epidural or subdural location, osteomyelitis, and bone flap wash were not associated with the primary outcome of treatment failure. Immediate replacement of the bone flap in the surgical management of pediatric subdural or epidural empyema is reasonable. Replacing the flap at the time of first surgery avoids the morbidity and costs of a subsequent reconstructive operation.

Neuronavigation-Guided Endoscopic Endonasal Drainage of Pediatric Anterior Cranial Base Epidural and Subdural Empyema

In children, epidural and/or subdural intracranial empyema can complicate frontal sinusitis or pansinusitis. The standard transcranial approach used to treat epidural or subdural empyema has many drawbacks, but these can be avoided with an endoscopic expanded endonasal approach (EEA). To support the feasibility and advantages of this approach, we report the successful drainage through endoscopic EEA of a bifrontal empyema caused by an intracranial extension of pansinusitis. Our case and the ones previously reported in the literature establish well that endoscopic EEA offers several advantages over the standard craniotomy. Hence, EEA should be considered as an alternative to the transcranial approach when surgically draining anterior skull base empyema resulting from pansinusitis in children.

HIV, Tuberculosis, and Otogenic Intracranial Sepsis: A Devastating Disease With a Subtle Presentation.

To undertake a large-scale review of otogenic intracranial sepsis in an area of highly prevalent HIV and tuberculosis (TB) to re-examine and inform early diagnosis and treatment efforts. Seventy-seven consecutive cases of otogenic intracranial sepsis in KwaZulu-Natal, South Africa were reviewed for demographics, presentation, imaging, HIV status, culture results, and outcomes. The most common intracranial complications were intracranial abscess (46.8%), hydrocephalus (31.2%), subdural empyema (28.6%), and epidural empyema (26.0%). Ear discharge (87.0%), postauricular abscess (29.9%), and hearing loss (29.9%) were notable presenting symptoms. Overall mortality was 15.6%. Of the 45.5% of patients with HIV testing, 54.2% were HIV+, Mortality among HIV+ patients was 15.8% but only 6.3% in HIV- patients (p = 0.61, OR = 2.8). Eight patients (10.4%) had culture or histological evidence of TB infection. Otogenic intracranial complications continue to present late and are associated with significant mortality and morbidity, despite advances in diagnostic and treatment modalities. This study represents one of the largest case-series in the literature, and the first to specifically evaluate the effects of HIV and TB infection.Patient presentation and severity of illness varied; however, a majority of patients presented with ear discharge and no focal neurological signs. An effect size for higher mortality among HIV+ patients compared with HIV- patients was noted but was not significant. Tuberculosis infection was prevalent compared with previous studies.This study reinforces the need for enhanced screening and early treatment of ear disease to minimize associated mortality and morbidity, particularly in immunocompromised patients.

Spinal epidural empyema extending from a pleural empyema: case description and anatomical overview

We present a case of a patient with diabetes with a pleural empyema originated from a pyomyositis process established after a central line procedure. This empyema later on extended into...

The use of endoscopic-assisted burr-hole craniostomy for septated chronic subdural haematoma: A retrospective cohort comparison study

ObjectiveTo complete a retrospective comparison of endoscope-assisted burr-hole craniostomy (EBHC) and ordinary burr-hole craniostomy (OBHC) in the treatment of septated chronic subdural hematoma (SCSH). MethodsA retrospective case note review comparing EBHC and OBHC of SCSH was therefore performed. Data of patients with a SCSH for EBHC or OBHC during the period from January 2011 to December 2016 were retrospectively collected and analysed. Of 73 patients, 42 underwent EBHC and 31 patients were treated by OBHC. The primary outcome measure was recurrence rate and secondary outcome measures were clinical outcome at first postoperative day, discharge and 6 months, the length of hospital stay for neurosurgery, the operative time, and the placement time of drainage tube. ResultThe rate of recurrence was significantly lower in the EBHC (0/42 0%) than in the OBHC (8/31, 25.8%) group (p = .0030). The rate of morbidity was significantly lower in the EBHC (2/42, 4.8%) than in the OBHC (11/31, 35.5%) group (p = .0121). At 30 days, mortality did not differ between groups. Significantly more patients treated with EBHC were alive at 6 months than were those with OBHC. No patient died as a consequence of the operative procedure in the both groups. A discharge GCS of 15 was recorded in more participants with EBHC than in those with OBHC. Gross neurological deficit was significantly less frequent in those with EBHC than in those with OBHC at first postoperative day and discharge, but did not differ at 6 month follow-up. The mean placement time of drainage tube was significantly less in those with EBHC (27.2 h) than in those with OBHC (52.0 h, p = .0055). The mean length of hospital stay for neurosurgery was 4 days in the EBHC group, while it was 5 days in the OBHC group (p = .0015). The mean hematoma reduction rate was significantly higher in those with EBHC than in those with OBHC at first postoperative day (85.3% vs 72.5%, p = .0037) and discharge (90.3% vs 85.1%, p = .0127). ConclusionComparing two minimally invasive procedure protocols for treatment of SCSH, EBHC is a safe and effective surgical technique. It significantly surpasses the results obtained in OBHC in lowering recurrence rate, morbidity rate, placement time of drainage tube, and length of hospital stay for neurosurgery. We recommend EBHC technique to be widely used in the treatment of SCSH, even common chronic subdural hematoma (CSH), subacute and acute subdural hematomas, acute epidural hematomas and empyemas to avoid large craniotomies, particularly in elderly patients, so that patients can receive the best treatment on the basis of minimal trauma.