Abstract
We studied the efficacy of two surgical methods used for the treatment of intracranial
subdural empyema (ISDE) at our centre. A cross-sectional study (1999–2005) of 90 patients
with non-traumatic supratentorial ISDE revealed that the two surgical methods used
for empyema removal were burr hole/s and drainage (50 patients, 55.6%) and a cranial
bone opening procedure (CBOP) (40 patients, 44.4%). Patients in the CBOP group had
a better result in terms of clinical improvement (chi-squared analysis, p = 0.006) and clearance of empyema on brain CT scan (chi-squared analysis, p < 0.001). Reoperation was more frequent among patients who had undergone burr hole surgery
(multiple logistic regression, p < 0.001). The outcome and morbidity of ISDE survivors were not related to the surgical
method used (p > 0.05). The only factor that significantly affected the morbidity of ISDE was level
of consciousness at the time of surgery (multiple logistic regression, p < 0.001). We conclude that CBOP and evacuation of the empyema is a better surgical method
for ISDE than burr hole/s and drainage. Wide cranial opening and empyema evacuation
improves neurological status, gives better clearance of the empyema and reduces the
need for reoperation. Level of consciousness at the time of presentation is a predictor
of the morbidity of ISDE. Thus, aggressive surgical treatment should occur as early
as possible, before the patient deteriorates.
Keywords
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Article info
Publication history
Accepted:
January 4,
2009
Received:
April 9,
2007
Identification
Copyright
© 2009 Published by Elsevier Inc.
