[How to manage intracranial empyemas in the absence of computerized tomography?]

Abstract

Background: Intracranial, and especially subdural, empyemas are a medical emergency usually requiring surgical intervention. We suggest herein a protocol for their management in areas where CT is not yet available.

Materials and methods: 16 patients with supratentorial empyemas (6 epidural abscesses, 6 subdural empyemas and 4 with both) diagnosed by surgical intervention in our department between 1986 and 1995 were studied. The etiological features were frontal sinusitis (7 cases), mastoid infection (1), trauma (5), previous operations (2) and unknown (1). Three patients were in a normal state of consciousness, 8 were drowsy and 5 were in a coma. Antibiotic treatment was empirical in 6 patients and specific in 10 patients. Surgical treatment was by multiple burr holes in 9 patients, small craniotomies in 3 patients, major craniotomies in 3 patients and by exploration of a previous craniotomy in 1 patient. A catheter was used for drainage in 12 patients.

Results: Average follow-up was 2.7 years. Two patients died, 3 had seizures and 11 were able to lead a normal life.

Conclusion: We recommend a regime of 2 or 3 antibiotics as an initial treatment. A number of factors including ecological environment, availability of drugs and financial circumstances of each patient should be considered when determining the treatment to be used. Surgical techniques vary according to the surgeon's experience. In our medical centre, drainage via burr-holes is the initial method of treatment for supratentorial empyemas.