Bifrontal decompressive craniectomy for acute subdural empyema.
BACKGROUND
Subdural empyema is an uncommon but serious complication of sinusitis. Despite the use of advanced imaging facilities, modern antibiotic therapy and aggressive neurosurgical protocols, this condition still carries significant morbidity and mortality.


METHODS
We report an unusual case of sinusitis-associated acute subdural empyema in a 13-year-old patient, presenting in a catastrophic manner with acutely raised intracranial pressure. Emergency bifrontal decompressive craniectomy was necessary both to reduce the intracranial pressure and to drain the subdural empyema.


RESULTS
The full range of intracranial complications subsequently occurred, including brain abscesses, recurrent subdural empyema and ventriculitis. Despite this, the patient's outcome was good, with minimal intellectual deficits.


CONCLUSIONS
In cases of severe intracranial infection, we therefore advocate an aggressive surgical approach coupled with appropriate antibiotics to ensure a good outcome.
Ong
Y K
YK
Department of Neurosurgery, Singapore General Hospital, Outram Road, Singapore 169608.
Goh
K Y C
KY
Chan
C
C
D000208:Acute Disease; D000293:Adolescent; D001930:Brain Injuries / Q000175:diagnosis* / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical; D013354:Empyema, Subdural / Q000601:surgery*; D005625:Frontal Lobe / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D015898:Tomography Scanners, X-Ray Computed