Pediatric parafalcine empyemas

Abstract

Subdural intracranial empyemas and brain abscesses are a rare complication of bacterial sinusitis. Pediatric parafalcine abscesses are a rare entity with different treatment compared with other brain abscesses. We present two pediatric cases with falcine abscess as a sinusitis complication and introduce our department's treatment management. In addition a review of literature is performed. Surgical cases of our department and their management are compared with the current literature. In our cases, both of the children showed a recurrent empyema after the first surgical treatment and antibiotic therapy. A second surgical evacuation was necessary. The antibiotic therapy was given for 3 months. Short-time follow-up imaging is necessary irrespective of infection parameters in blood and patient's clinical condition. Especially in parafalcine abscesses a second look may be an option and surgical treatment with evacuation of pus is the treatment of choice if abscess remnants are visualized.

Figure 1:

Twelve-year-old boy with parafalcine subdural empyema. (A) Axial and saggital MRI section with administration of gadolinium. A parafalcine subdural empyema frontoparietal with left-side compression of the brain. It is seen a diffuse edema of the left hemisphere. (B) Axial native CT section. An enlargement of the empyema is visible 4days after first surgery with a diffuse edema of the left hemisphere without a significant midline shift. (C) Axial and sagittal MRI section with administration of gadolinium. Regression of the empyema is visible after the second surgery. A regressive edema of the left hemisphere is visible, especially the frontal abscess conglomerate is reduced.

Figure 2:

Eight-year-old girl with parafalcine subdural empyema. (A) Axial and sagittal MRI section with administration of gadolinium. Space occupying empyema with the largest expansion right frontal and contact to the falx. Perifocal edema without a significant midline shift is seen. (B) Axial and sagittal MRI section with administration of gadolinium. An enlargement of the empyema is visible after first surgery. The empyema is localized in central parasagittal region with a significant space-occupying component with a compression of the right central region. (C) Axial and sagittal MRI section with administration of gadolinium. A regression is visible after second surgery. In comparison to preoperative MRI, a notable decrease in the space-occupying part of the empyema is seen.