Article
Subdural empyema in children: therapeutic strategy: about five cases
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Published: | May 4, 2005 |
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Outline
Text
Objective
The goal of this study is to determinate the accuracy of an “aggressive” surgical management of subdural empyemas (SDE) in children and young adults.
Methods
Four boys and one girl, aged from three month to 18 years at time of diagnosis (median age: 7 years) were admitted in our institution for SDE. SDE following intracranial surgery were excluded from the study. The data were reviewed retrospectively.
Results
All patients were treated surgically (burr hole evacuation or craniotomy, repeated in some cases), followed by intravenous antibiotherapy (mean time: 52 days) adapted to the micro-organism. Only the two patients treated by large craniotomy at first had a single surgical procedure. Involved micro-organisms are as follow: Streptococcus intermedius (N=2), Streptococcus Pneumoniae (N=1), Escherichia Coli (N=1), absence of any identified micro-organism (N=1). The five patients are alive (median follow-up: 22 month) without any sequelae.
Conclusions
We advocate an aggressive surgical treatment of SDE in children with a large bone flap to allow the surgeon to remove pus and membranes as much as possible, even in the interhemispheric fissure, followed by intravenous appropriate antibiotherapy and eradication of the source of infection. Even this “aggressive” treatment may sometimes not avoid re-operation. A careful follow-up is mandatory, because of the high risk of recurrence.