Treatment Of Subdural Empyema Research Articles

Infantile supratentorial subdural empyema managed by percutaneous aspiration: an outcome study in a Nigerian city.

Subdural empyema (SDE), a common neurosurgical emergency in the developing countries, accounts for 15%-20% of localised paediatric intracranial infections. In regions where modern diagnostic tools are scarce and inaccessible, detection of SDE may be delayed with subsequent poor outcome. Percutaneous subdural aspiration in patients with open anterior fontanel may be the only surgical option in resource-poor regions of the world. This review focuses on the management outcome, including neurological outcome of these children. Clinical charts of children with SDE and treated by percutaneous subdural tap between February 2006 and August 2014 were reviewed. Demographic, clinical, radiological, bacteriological parameters and outcome data were analysed. Forty-five children with a mean age of 10.6 ± 6.2 months (range: 2-17 months) and followed up for a median duration of 16.4 months were included. The most frequent clinical features were enlarged head circumference, fever, focal neurologic deficits and altered level of consciousness. Diagnosis of SDE was confirmed using trans-fontanel ultrasound scan in 32 (71.1%) children, computerised tomography in 12 (26.7%) children and magnetic resonance imaging in one (2.2%) child. SDE was unilateral in 73.3% and bilateral in 26.7%. In 23 (51.1%) children with a positive culture, Staphylococcus aureus (n = 10), anaerobes (n = 7), Escherishia coli and Haemophilus influenza (n = 6 each) were the most common organisms. Forty-three children (95.6%) survived, 36 of which had good Glasgow outcome score. Seven children still had moderate deficits at 3 months. Treatment of SDE in young children with patent fontanel using percutaneous subdural tap has good therapeutic and neurological outcome.

Conservative treatment of subdural empyema: a complication of odontogenic sinusitis

Conservative treatment of subdural empyema: a complication of odontogenic sinusitis

Infantile subdural empyema: The role of brain sonography and percutaneous subdural tapping in a resource-challenged region.

Background:This study explored the outcome of children with patent anterior fontanelles who were treated with trans-fontanelle ultrasound scan (TFUSS), which is more affordable and available than CT scan and MRI in the diagnosis of childhood intracranial pathologies and treatment of subdural empyema, in developing countries.Patients and Methods:Seventeen infants with post-meningitic subdural empyema, diagnosed using trans-fontanelle ultrasound alone and treated with subdural tapping over a 31-months period, were studied.Results:Eleven patients presented with grades II and III Bannister and William grading for level of consciousness in intracranial subdural empyema. Aspirate from 7 (41.2%) patients were sterile. The most common organisms isolated were Streptococcus faecalis 3 (17.6%), Haemophilus Influenza 2 (11.8) and Staphylococcus aureus 2 (11.8), multiple organisms were isolated in three of the patients. Ninety-four percent (94%) of the patients had good outcome. Five subjects developed hydrocephalus, one patient had a recurrence of subdural empyema, four patients had residual hemiparesis, two of the four patients had speech difficulties, while one patient (~6%) died.Conclusion:While CT and MRI remain the gold standard for investigating intracranial lesions, transfontanelle ultrasonography is adequate for diagnosis of infantile subdural empyema in resource-challenged areas. Percutaneous subdural tap is an affordable and effective therapy in such patients with financial challenges.

Urine saturation and promoter/inhibitor parameters and ratios in renal stone disease caused by ceftriaxone

Abstract During ceftriaxone treatment of subdural empyema caused by Streptococcus intermedius urinary and biliary stones were noticed. Increased levels of urinary calcium excretion were detected during ongoing treatment in comparison with 2 months check-up. There were no significant changes in the promoter/inhibitor urolithiasis parameters, oxalate, citrate, urate, cistine, glycosaminoglycans or their ratios. Urine saturation was calculated using EQUIL 2 computer programme (calcium oxalate, brushite) and it was normal. Probable trigger for the ceftriaxone/calcium hydroxy carbonate phosphate mixture of stones was a critical boost of solubility products caused by ceftriaxone treatment and phospnate urine content with a subsequent large-scale spontaneous precipitation of crystals.

Nonsurgical treatment of infratentorial subdural empyema: A case report

Infratentorial subdural empyemas are rare. It is an important neurological infection requiring immediate neurosurgical treatment. The nonsurgical treatment of subdural empyema has been reported sporadically. In this paper the authors report the nonsurgical treatment of a case of infratentorial subdural empyema. The patient with left recurrent otitis was hospitalized with symptoms of headache and fever of 3 weeks duration. Examination revealed that the patient had Glasgow Coma Scale score of 15, fever, mild cerebellar signs, no focal deficit, and abundant suppuration from the left ear. A contrast-enhanced CT scan showed an infratentorial supracerebellar hypodense fluid collection with the peripheral rim enhancement to the left of the midline that mimicked a subdural empyema. Routine hematological investigation revealed polymorphic leukocytosis and elevated erythrocyte sedimentation rate. After the left mastoidectomy and antibiotic treatment, the patient recovered with complete resolution of the subdural empyema on CT scan.

The treatment and outcome of postmeningitic subdural empyema in infants

The management of subdural empyema (SDE) has been debated in the literature for decades. Craniotomy and bur hole drainage have been shown to achieve a favorable outcome. However, there is a lack of comparative data for these modes of management of SDE subsequent to meningitis in infants. The authors conducted a retrospective review of 33 infants identified with SDE due to meningitis at the Department of Neurosurgery, Chang Gung Memorial Hospital between 2000 and 2006. Preoperative clinical presentation, duration of symptoms, radiological investigations, CSF data, and postoperative outcome were analyzed and compared between these 2 surgical groups. At diagnosis, there were no differences between the groups in age, weight, degree of consciousness, CSF analysis, or duration of fever. The outcome data showed no difference in the number of days until afebrile, number of days of postsurgical antibiotic treatment, neurological outcome, recurrence rate, or complication rate. There was only 1 death in the series. Subdural empyema due to meningitis in infants is unique with respect to the pathophysiology, presentation, and treatment of SDE. Early detection and removal of SDE provide a favorable outcome in both surgical intervention groups. Bur hole drainage is less invasive, and it is possible to expect a clinical outcome as good as with craniotomy in postmeningitic SDE.

Challenges in the Management of Intracranial Subdural Empyema

Subdural empyema (SDE) is a rare form of intracranial sepsis that can rapidly lead to death. This fatal outcome is potentially preventable if the diagnosis is made at an early phase of the disease process and appropriate treatment measures are implemented in time. A case series of 6 patients is presented, illustrating the difficulties encountered in the diagnosis and treatment of SDE. The pathoanatomical basis of SDE is highlighted, and management challenges encountered in treating the condition, namely, difficulties hindering early diagnosis and controversies in optimal surgical approach, are addressed.

硬膜下膿瘍の外科的治療 : 自験2例の報告と文献的考察

症例は10カ月男児と43歳男性.前者は腰部先天性皮膚洞の感染から硬膜下膿瘍をきたし, 後者は前頭洞炎からの波及が疑われた.両者ともに, 穿頭ドレナージ術と抗生剤の局所および全身投与により治癒せしめ得た.後者では膿瘍腔の持続灌流も有効であった.文献的に硬膜下膿瘍の外科的治療成績は, CT登場前後で, 死亡率が約30%から約10%にまで改善し, 特に穿頭ドレナージ術の手術成績は開頭術による成績と遜色ないまでに改善していた.X線CTにより早期の正確な局在診断と経過観察が容易に行えるようになり, 低侵襲で術式も容易な穿頭ドレナージ術の重要性が増しているものと考えられた.

Intracranial Abscesses in Western Saudi Arabia

The clinical symptoms of brain abscesses are indistinguishable from those of other intracranial space-occupying lesions. The underlying etiology is generally found to be spread of infection from an...

Successful treatment of subdural empyema due to Serratia marcescens.

Successful treatment of subdural empyema due to Serratia marcescens.

Treatment of subdural empyema

A review of 66 cases and a survey of the literature indicates that survival rates of around 90% should now be expected from patients with subdural empyema. Factors affecting the outcome are discussed. In addition to prompt surgical treatment and appropriate antibiotic therapy, the most important step seems to be extensive craniotomy and direct removal of subdural pus, particularly from the interhemispheric fissure. Treatment through burr holes is not acceptable. In the absence of a culture of the organisms and known antibiotic sensitivities, chloramphenicol is recommended as the drug of choice.