Subdural Empyema in Infants

OBJECTIVE: The goal of this study was to review the etiologies, phathophysiology, clinical presentations and to compare the results of the surgical methods of subdural empyema especially in infants. PATIENTS AND METHODS: We reviewed the clinical data of five infantile subdural empyemas experienced in our hospital from 1993 to 1998 which were all surgically treated by craniotomy or burr hole trephination. We experienced five cases of infantile subdural empyema: two males and three females. The ages ranged from 40 days to 11 months. RESULTS: The etiologies of all five cases were unproven but all five cases had meningitis before the subdural empyemas were diagnosed. The causative organism in one was streptococcus pneumoniae, and the other were unknown. Two were treated with craniotomy(one with a good outcome and the other died) and three were treated with burr hole trephination(all three had a good outcome). CONCLUSION: Subdural empyema is a rapid progressing disease and it is important to detect and treat in the early stages of disease. The choice of surgical method must be based on the stage of the disease and its location in the cranial cavity.

Traumatic Intracranial Aneurysms: Report of Six Cases

Six cases of traumatic intracranial aneurysms are presented, two located on the internal carotid artery, two on the anterior cerebral artery, one on the middle cerebral artery, and one on the middle meningeal artery. Three of the 6 cases were associated with skull fracture. Five cases were treated:two by clipping, two by trapping and one by excision & coagulation of the lesion. Due to increasing use of brain CT to substitute angiogram during the initial surveys of head injury patients, traumatic aneurysms are often overlooked and the diagnosis delayed. Since the clinical course of traumatic aneurysm is variable and its high mortality rate, immediate cerebral angiography & early proper treatment are recommended whenever clinical suspicion of traumatic aneurysm is aroused or/and delayed neurological deterioration is detected after head injury. In this study, the authors tried to find out the clues for early diagnosis of traumatic intracranial aneurysms.

Clinical Analysis of Multiple Intracranial Aneurysms

In this retrospective clinical analysis for 143 patients who underwent operation due to multiple intracranial aneurysms during the last 12 years(1983-1994), we intended to find out the clinical characteristics, the significant signs for the differentiation between ruptured and unruptured aneurysm, and to compare the results of one-stage operations with those of two-stage operations. The results were s follows; Of 864 patients operated on due to intracranial aneurysms, 143 patients(16.6%) had two or more intracranial aneurysms. Multiple aneurysms were more common in females, with a female to male ratio of 2.4 : 1 as compared with 1.3 to 1 for patients with single aneurysm. Common locations of the aneurysms were the middle cerebral artery, and posterior communication artery, anterior communicating artery, and the anterior choroidal artery, in that order. In identifying the site of rupture, the focal hematoma in brain CT scan, segmental vasospasm, irregularity and sizes of aneurysmal sacs on angiograms were helpful. Aneurysms 3mm or less were less prone to rupture. However, for those with a diameter of more than 4mm, the frequency of rupture increased with the size of aneurysm. Eighty eight percent of patients who underwent operations had a favorable outcome and the operation mortality rate was 7.7%. In patients of Grade I and II, surgical results of the one-stage operation group and two-stage operation group did not differ. In Grade III patients, the results were better for the two-stage operation group, without statistical significance. From our studies we have come to the conclusion that incidental aneurysms found in patients with low risk should be treated at the same time when ruptured aneurysms are clipped.