ORIGINAL ARTICLES
Contemporary management of intracranial subdural empyema: An institutional experience
Edward Olaoluwa Jolayemi1, Olufemi Babatola Bankole2, Omotayo Abimbola Ojo2, Babatunde Bamigboye3, Bamidele Oludele Adebayo4, Bruno Jeneru Arekhandia1, Chinyere Nkiruka Asoegwu3, Olubukola Iretiogo Alabi5, Uzoma Chinedu Ifezue5, Clement Chukwuemeka Nwawolo3, Okezie Obasi Kanu2
1 Department of Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
2 Department of Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
3Department of Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria; Department of Otorhinolaryngology, Head and Neck Surgery, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
4 Neurosurgery Unit, Department of Surgery, Federal Medical Center, Abeokuta, Ogun State, Nigeria
5 Department of Anaesthesia, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
Correspondence Address:
Dr. Okezie Obasi Kanu
Department of Surgery, College of Medicine, University of Lagos, PMB 12003, Surulere, Lagos State
Nigeria
Source of Support: None
Conflict of Interest: None
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Background: Intracranial subdural empyema (SDE) is a seemingly uncommon life-threatening ailment with varying presentations and outcomes. A variety of risk factors have been associated with predisposition to intracranial SDEs; however, they may be cryptogenic. There is an increased predilection for intracranial SDE in children and teenagers with paranasal sinusitis or middle ear infections. The clinical presentation is non-specific and thus a high index of suspicion is required. Neuroimaging is an invaluable diagnostic tool for early diagnosis and surgical intervention. There have been multiple proponents for either burr hole or craniotomy to treat intracranial SDEs; however, despite surgical intervention, adverse neurologic sequelae and even mortality still occur. Extended antibiotic therapy is mandatory and impacts significantly on patients’ outcomes.
Objective: This study describes the demographics, clinical presentation, and surgical outcomes in patients with intracranial SDEs over the study period. Design: This is a retrospective single-centre case series.
Setting: This study takes place in a tertiary referral centre, university hospital.
Materials and Methods: This was a retrospective review of patients presenting with intracranial SDEs over a 10-year period in a tertiary neurosurgical unit serving south-western Nigeria. Demographic, clinical, and radiologic data were retrieved from patient records.
Results: Forty-nine patients presented with intracranial SDEs during the review period. These patients aged between 16 months and 75 years, most of whom were 20 years of age and below. The mean age was 21.37 ± 19.29 years with a median age of 15 years. There were 35 males and 14 females giving a male-to-female ratio of 2.5:1. The most common presentations were headache (73.5%), altered sensorium (55.1%), and seizures (38.8%). Forty patients (81.6%) had evacuation of SDE by burr hole and subdural washout. There was a significant post-op residual SDE in six patients. There were eight (16.3%) mortalities in this series. Forty-seven (95.9%) patients had sterile cultures of the subdural pus collection.
Conclusion: Intracranial SDE affects mostly children and teenagers. Early diagnosis, emergent surgery, extended antibiotic therapy, and concurrent source control employing a multidisciplinary approach are essential in managing this condition. Burr hole and subdural washout help control the disease process, reduce operation time, and may yield outcomes similar to craniotomies, which are more invasive.
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