ABSTRACT
INTRODUCTION AND IMPORTANCE: Subdural empyema (SE) following chronic subdural hematoma (CSDH) surgery is an uncommon but serious complication. The best treatment approach, typically a choice between craniotomy and burr hole surgery, is still debated. This case report introduces an innovative method using burr hole surgery with double-tube irrigation, a potentially effective alternative to the more invasive craniotomy. CASE PRESENTATION: An 81-year-old male, 48 days post-CSDH surgery, developed SE with Methicillin-resistant Staphylococcus aureus infection. The initial treatment with burr hole drainage was complicated by recurrence, leading to a second procedure with double tubes inserted anteriorly and posteriorly for continuous irrigation therapy. The patient was treated with systemic antibiotics and vancomycin irrigation, resulting in successful resolution without further recurrence. CLINICAL DISCUSSION: While burr hole surgery is often deemed less effective than craniotomy for SE, this case demonstrates the potential efficacy of double-tube irrigation via burr hole surgery. This method could be especially beneficial when craniotomy poses significant risks. Continuous irrigation could help in managing intracranial pressure, making the intervention safer. However, further research is needed to refine this technique and establish clear treatment guidelines. CONCLUSION: Burr hole surgery with double-tube irrigation emerges as a promising treatment option for SE, especially when craniotomy is not feasible. This approach's success in this case encourages further exploration and study to validate its wider application in similar clinical scenarios.
ABSTRACT
Stent-assisted coil embolization is effective for treating intracranial aneurysms, improving outcomes and reducing recurrence rates. However, accurately measuring the diameter of a previously placed stent during imaging can be challenging due to coil artifacts. This poses difficulties in determining the coil packing and size of additional stents needed during retreatment. In a reported case, the use of a balloon enabled precise assessment of stent deployment. A 50-year-old male with a history of basilar artery-left superior cerebellar artery aneurysm underwent coil embolization, direct clipping, and stent-assisted coil embolization (SAC) over a span of 14 years. However, the aneurysm showed reenlargement over time. To address the recurrence, a balloon was used to assess the previously placed Neuroform Atlas stent. Additional coils were inserted outside the stent, and a Low-profile Visualized Intraluminal Support Blue stent was added. Postoperatively, there were no new neurological issues, and a follow-up magnetic resonance imaging showed no ischemic lesions . Balloon-assisted stent visualization (BASV) may be a useful method in the retreatment of SAC. It has the potential to provide valuable information for treatment planning.