Primary interhemispheric subdural empyemas: A report of three cases and review of literature

Abstract

Background

Interhemispheric subdural empyema is an uncommon condition and is considered neurosurgical emergency. These are generally seen following neglected otorhinological infection, but may be posttraumatic or iatrogenic in origin. The source of infection can be frequently found, but in few cases no source of infection can be identified, called idiopathic empyemas. These idiopathic interhemispheric subdural empyemas are even rare. They can present with a rapid progression of symptoms and can carry poor prognosis. Early intervention with craniotomy and appropriate antibiotics can improve the condition of these patients.

Materials and Methods

We present three cases of idiopathic interhemispheric empyemas who underwent emergency craniotomy and evacuation followed by antibiotics for 6 weeks.

Results

All the patients had excellent recovery on mean follow-up of 10 years.

Conclusion

Early diagnosis and treatment of interhemisheric subdural empyema can lead to excellent recovery and outcome.

Key words

Craniotomy - interhemispheric subdural empyema - neurosurgical emergency - primary empyemas

• References

• 1 Bhandari YS. Sarkari NBS: Subdural empyema. A review of 37 cases. J Neurosurg 1970; 32: 35-39
• 2 Kubik CS, Adams RD. Subdural empyema. Brain 1943; 66: 18-42
• 3 Courville CB. Subdural empyema secondary to purulent frontal sinusitis. Arch Otolaryngol 1944; 39: 211-230
• 4 Hlavin ML, Kaminski HJ, Fenstermaker RA, White RJ. Intracranial suppuration: A modern decade of postoperative subdural empyema and epidural abscess. Neurosurgery 1994; 34: 974-981
• 5 Nathoo N, Nadvi SS, Gouws E, Van Dellen JR. Craniotomy improves outcomes for cranial subdural empyemas: Computed tomography-era: Experience with 699 cases. Neurosurgery 2001; 49: 872-878
• 6 Remmler D, Boles R. Intracranial complications of frontal sinusitis. Laryngoscope 1980; 90: 1814-1824
• 7 Ceci A, Onetti G. Ascesso intercranio, craniotomia explorativa della clinica chirurg. Della Universita di Genova, 1886. Ref. V. Bergmann: Die Chirurg. Beh. V. Hirnkrankj. 11. Auffl., s. 80. 1889.
• 8 Renaudin JW. Cranial epidural abscess and subdural empyema. In: Willkins RH, Rengachary SS. editors Neurosurgery. Vol. 2. 2^nd ed. USA: McGraw-Hill; 1985. p 3313-3315
• 9 Li NG. Interhemispheric subdural empyema. Zhonghua Wai Ke Za Zhi 1989; 27: 424-425
• 10 Van DJ, Boles DM, Van DH. Interhemispheric subdural empyema. S Afr Med J 1977; 52: 266-269
• 11 Basit AS, Ravi B, Banerji AK, Tandon PN. Multiple pyogenic brain abscesses: An analysis of 21 patients. J Neurol Neurosurg Psychiatry 1989; 52: 591-594
• 12 Yende AK, Mohanty S. Massive falx cerebri empyema. Neurol India 2003; 51: 65-66
• 13 Nathoo N, Nadvi SS, Van Dellen JR. Traumatic cranial empyemas: A review of 55 patients. Br J Neurosurg 2000; 14: 326-330
• 14 Van Alphen HA, Dreissen JJ. Dreissen-Brain ascess and subdural empyema. Factors influencing mortality and results of various surgical techniques. J Neurol Neurosurg Psychiatry 1976; 39: 481-490
• 15 Mahapatra AK. Subdural Empyema in a child with posterior urethral valve. Indian J Pediatr 1985; 52: 429-431
• 16 Stephanov S, Sidani AH, Amacker JJ. Interhemispheric subdural empyema--case report. Swiss Surg 2001; 7: 229-232
• 17 Jaiswal AK, Kumar S, Singh AK, Bundela YP. Interhemispheric Subdural Empyemas. Pan Arab J Neurosurg 2009; 13: 124-125
• 18 List CF. Diagnosis and treatment of acute subdural empyema. Neurology 1955; 5: 663-670
• 19 Yerdura J, White RJ, Resnikoff S, Brown H. Interhemispheric subdural empyema: Angiographic diagnosis and surgical treatment. Surg Neurol 1975; 3: 89-92
• 20 Mitsuoka H, Tsunoda A, Mori K, Tajima A, Maeda M. Hypertrophic anterior falx artery associated with interhemispheric subdural empyema. Neurol Med Chir 1995; 35: 830-832
• 21 Krishna CV, Williams JP, Brennan TG, Kosnik E. Interhemispheric subdural empyema. Neuro radiological diagnosis. Childs Brain 1978; 4: 106-113
• 22 Kagawa R, Shima T, Matsumura S, Okada Y, Nishida M, Yamada T. et al Idiopathic interhemispheric subdural abscess: Report of a case. No Shinkei Geka 1989; 17: 647-652
• 23 Rao KC, Williams JP, Brennan TG, Kosnik E. Interhemispheric subdural empyema: Neuroradiological diagnosis. Child’s Brain 1978; 4: 106-113
• 24 Weingarten K, Zimmerman RD, Becker RD, Heier LA, Haimes AB, Deck MD. Subdural and epidural empyemas: MR imaging. AJR Am J Roentgenol 1989; 152: 615-621
• 25 Kawano H, Yonemura K, Misumi Y, Hashimoto Y, Hirano T, Uchino M. A case of interhemispheric subdural empyema with sinusitis diagnosed by diffusion-weighted MRI. Rinsho Shinkeigaku 2005; 45: 449-452
• 26 Kenneth F, Swaiman MD, Laurence HA, Gold MD. An unusual computed tomographic appearance of a subdural empyema. J Paediatr 1977; 91: 945-947
• 27 Hayakawa I, Fukui M, Furuhashi N, Kanda T, Tazaki Y. Interhemispheric subdural empyema diagnosed by CT and cured by antibiotic therapy. Rinsho Shinkeigaku 1981; 21: 810-817
• 28 Lalkaka JA, Parikh JM, Nath AR, Meisheri YV, Vengsarkar US, Deshpande DV. Interhemispheric empyema. An unusual form of subdural empyema. J Assoc Physicians India 1989; 37: 394-396
• 29 Helfgott DC, Weingarten K, Hartman BJ. Subdural empyema. In: Scheld WM, Whitley RJ, Durack DT. editors Infections of the Central Nervous System. New York: Raven Press; 1997. p 495-505
• 30 Farkas AG, Marks JC. Subdural empyema: An important diagnosis not to miss. Br Med J 1986; 293: 118-119