RESUMO
Subdural empyema [SDE] is a rare form of intracranial sepsis that can rapidly lead to death. This fatal outcome is preventable as the condition can be treated successfully if the diagnosis is made at an early phase of the disease process and appropriate treatment measures are implemented in time. We present 6 cases of SDE out of a total of 71 patients treated for intracranial infections in the Neurosurgery Unit of Hamad General Hospital in Doha. Qatar in the period from January 1996 - December 2000. Fever and headache were the most common symptoms and there were neurological deficits in all patients by the time they were referred to neurosurgical care. Contrast enhanced computerised tomography scan of the brain was diagnostic in all patients although in two of them the initial studies were negative and the subdural collection was only revealed on follow-up imaging. The source of SDE was the paranasal sinuses in 4 patients, gram-negative septicaemia in 1 and was unknown in the sixth patient. Subdural pus collection was more or less confined to one lobe or another of the cerebral hemisphere in 4 patients, all of whom underwent burr hole drainage. In the remaining 2 patients the subdural pus had spread over most of the cerebral hemisphere as well as the interhemispheric space. In each of these cases, a more extensive surgical procedure, in the form of a craniotomy or a craniectomy was required. Subdural pus culture grew streptococcus milleri in 4 patients and was sterile in 1 patient while Burkholderia pseudomalleri was isolated from the blood and subdural pus in the sixth patient. Besides surgical procedures for drainage of SDE, 4 patients also underwent drainage of paranasal sinuses by the ENT surgeons. All patients received intravenous antibiotics for an average of 4 weeks followed by oral antibiotics for about 4 more weeks. A full neurological recovery was achieved in 4 patients with a mean follow-up of 12 months. One patient failed to attend the outpatient clinic for follow-up and there was 1 death that was almost certainly attributed to the delay in diagnosis. The objective of this article is to review the patho-anatomical basis of SDE and address management challenges encountered in treating the condition, namely difficulties hindering early diagnosis and controversies regarding the optimum surgical approach