Intracranial subdural empyemas in the era of computed tomography: A review of 699 cases

OBJECTIVE: Intracranial empyemas are the most common form of intracranial suppuration seen in our unit and, despite modern antibiotic therapy and advanced neurosurgical and imaging facilities, these pus collections remain a formidable challenge, often resulting in significant morbidity and death. We present an analysis of our 15-year experience with this condition in the era of computed tomography. METHODS: A retrospective analysis of 4623 patients admitted with intracranial sepsis during a 15-year period (1983-1997) identified 699 patients with intracranial subdural empyemas. The inpatient notes for these patients were analyzed with respect to clinical, radiological, bacteriological, surgical, and outcome data. Statistical analyses were performed. RESULTS: The 699 intracranial subdural empyemas accounted for 15% of all admissions for intracranial sepsis during the study period. Young male patients in the second or third decade of life were most commonly affected (62%), and the mean age was 14.65 +/- 12.2 years. Almost all patients (96%) underwent surgery. Eighty-two percent of patients experienced good outcomes (Glasgow Outcome Scale scores of 4 or 5). A morbidity rate of 25.9% (including postoperative seizures) was noted, and 85 patients died (mortality rate, 12.2%). CONCLUSION: Intracranial subdural empyema, which is a neurosurgical emergency, is rapidly fatal if not recognized early and managed promptly. Early surgical drainage, simultaneous eradication of the primary source of sepsis, and intravenous administration of high doses of appropriate antibiotic agents represent the mainstays of treatment.