The treatment and outcome of postmeningitic subdural empyema in infants.
OBJECTIVE
The management of subdural empyema (SDE) has been debated in the literature for decades. Craniotomy and bur hole drainage have been shown to achieve a favorable outcome. However, there is a lack of comparative data for these modes of management of SDE subsequent to meningitis in infants.


METHODS
The authors conducted a retrospective review of 33 infants identified with SDE due to meningitis at the Department of Neurosurgery, Chang Gung Memorial Hospital between 2000 and 2006. Preoperative clinical presentation, duration of symptoms, radiological investigations, CSF data, and postoperative outcome were analyzed and compared between these 2 surgical groups.


RESULTS
At diagnosis, there were no differences between the groups in age, weight, degree of consciousness, CSF analysis, or duration of fever. The outcome data showed no difference in the number of days until afebrile, number of days of postsurgical antibiotic treatment, neurological outcome, recurrence rate, or complication rate. There was only 1 death in the series.


CONCLUSIONS
Subdural empyema due to meningitis in infants is unique with respect to the pathophysiology, presentation, and treatment of SDE. Early detection and removal of SDE provide a favorable outcome in both surgical intervention groups. Bur hole drainage is less invasive, and it is possible to expect a clinical outcome as good as with craniotomy in postmeningitic SDE.
Liu
Zhuo-Hao
ZH
Department of Neurosurgery, Chang Gung Memorial College of Medicine, Hospital and Chang Gung University, Linkou, Taiwan.
Chen
Nan-Yu
NY
Tu
Po-Hsun
PH
Lee
Shih-Tseng
ST
Wu
Chieh-Tsai
CT
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003399:Craniotomy; D013354:Empyema, Subdural / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000601:surgery*; D020814:Meningitis, Escherichia coli / Q000175:diagnosis / Q000601:surgery; D008583:Meningitis, Haemophilus / Q000175:diagnosis / Q000601:surgery; D008586:Meningitis, Pneumococcal / Q000175:diagnosis / Q000601:surgery; D009460:Neurologic Examination; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis / Q000601:surgery; D013292:Streptococcus agalactiae; D014057:Tomography, X-Ray Computed; D014207:Trephining
D000900:Anti-Bacterial Agents