RESUMO
PURPOSE: Subdural empyemas are considered neurosurgical emergencies, and the parafalcine location is particularly insidious. We revised the experience of general surgeons who are used to manage chronic pleural purulent collections with video-assisted thoracoscopy. METHODS: With a similar technique, we successfully aspirated a parafalcine empyema using a flexible scope avoiding a more invasive craniotomy. A review of the treatment options of empyematous collections is also provided, focusing particularly on the hazardous parafalcine location. RESULTS: The management of subdural empyemas poses different decision-making problems compared to common brain abscesses, urging a more rapid and holistic surgical treatment with minimally invasive approach. Endoscopic aspiration of parafalcine empyema was followed by complete recovery in our patient. CONCLUSIONS: Flexible endoscopy is a promising method to obtain complete pus removal even from loculated collections through a bur hole, avoiding large craniotomies and consequent potential complications.
Assuntos
Drenagem/métodos , Empiema Subdural/cirurgia , Endoscópios , Adolescente , Craniotomia/métodos , Empiema Subdural/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
A review of the literature reveals only a few cases of spinal subdural empyema. Etiologies of spinal subdural empyema include hematogenous spread from skin lesions, systemic sepsis, direct spread from spinal osteomyelitis and complications of discography. However, in this report, we describe a patient who developed spinal subdural empyema following several cervical acupuncture sessions. Operative treatment with adequate laminectomy, removal of abscess, and copious irrigation resulted in good recovery. Microbiologic culture study of pus obtained at surgery was positive for Staphylococcus aureus. The need for sterilization procedures for acupuncture is emphasized and a brief review of the relevant literature is presented.
Assuntos
Terapia por Acupuntura/efeitos adversos , Vértebras Cervicais , Empiema Subdural/etiologia , Adulto , Vértebras Cervicais/cirurgia , Empiema Subdural/patologia , Empiema Subdural/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Manejo da DorRESUMO
Cases of intracranial sepsis of otorhinogenic origin presenting to a regional neurosurgical centre from 1984 to 1992 were examined with regard to their microbiology and antibiotic sensitivities. The results lead us to believe that cefotaxime may have a role in the initial ENT management of the potentially complicated case of ear or sinus sepsis.