Subdural empyema surgery
|
Subdural empyema Microchapters |
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Subdural empyema surgery On the Web |
|
American Roentgen Ray Society Images of Subdural empyema surgery |
|
Risk calculators and risk factors for Subdural empyema surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Subdural empyema, also referred to as subdural abscess, pachymeningitis interna and circumscript meningitis, is a life-threatening infection, first reported in literature approximately 100 years ago.[1] It consists of a localised collection of purulent material, usually unilateral, between the dura mater and thearachnoid mater. It accounts for about 15-22% of the reported focal intracranial infections. The empyema may develop intracranially (about 95%) or in the spinal canal (about 5%), and in both cases, it constitutes a medical and neurosurgical emergency.[2] Since the clinical symptoms might be mild and unspecific initially, the rapid diagnosis and treatment are crucial. The sooner the proper treatment is initiated, the better the recovery will be. The treatment, for almost all causes, requires prompt surgical drainage and antibiotic therapy.[2] With treatment, resolution of the empyema occurs from the dural side, and, if it is complete, a thickened dura may be the only residual finding. With treatment, including surgical drainage, resolution of the empyema occurs from the dural side, and, if it is complete, a thickened dura may be the only residual finding.
Surgical Treatment
Except in its mildest stages, or in the presence of contraindications, subdural empyema is a neurosurgical condition, which requires emergency surgical drainage and medical therapy. Early diagnosis, appropriate surgical drainage and adequate antibiotic therapy are the key to a favourable outcome. Following the surgical procedure, the pus from the empyema should be sent for aerobe and anaerobic cultures, in order to determine the most adequate antibiotic therapy. Except in rare situations, where the is contraindication for surgery, or the mortality risk is greater, subdural empyema should always be treated surgically. Other concomitant situations, such as sinusitis, otitis and mastoiditis, may also require surgical intervention[1][2]
There are two surgical procedures, that aim to evacuate completely the pus from the empyema:
Burr hole placement
In the burr hole placement technique, a previous imaging study accurately localizes the collection of pus to be evacuated.
Craniotomy
A wide craniotomy with irrigation is the surgical procedure of choice, since it allows wide exposure of the area, adequate exploration and better evacuation of the infected material, thereby improving the outcome. [2][1] Craniotomy is also the indicated surgical procedure in the presence of large or multiloculated infections and empyemas refractory to drainage by burr hole or stereotactic aspiration. [2]
Below is a video demonstrating a clinical case in which surgery was part of the treatment
{{#ev:youtube|-DziqU6wnz8}}
Video curtesy of Neurosurgery (youtube)
References
- ↑ 1.0 1.1 1.2 Agrawal, Amit; Timothy, Jake; Pandit, Lekha; Shetty, Lathika; Shetty, J.P. (2007). "A Review of Subdural Empyema and Its Management". Infectious Diseases in Clinical Practice. 15 (3): 149–153. doi:10.1097/01.idc.0000269905.67284.c7. ISSN 1056-9103.
- ↑ 2.0 2.1 2.2 2.3 2.4 Greenlee JE (2003). "Subdural Empyema". Curr Treat Options Neurol. 5 (1): 13–22. PMID 12521560.