Tokunaga Y, Inoue M, Ishizaka H, Koga H, Kawano T, Mori K
No Shinkei Geka. 1985 Apr;13(4):433-6.
A case of encapsulated subdural empyema was reported. This 1.5-year-old boy was admitted with the increasing confusion and convulsion. Eight months prior to admission, he had craniotomy for traumatic acute epidural hematoma on the left side. Following a coagulation of the middle meningeal artery which was the bleeding source, the dura was opened but no cortical damage was noted at that time. The computed tomographic (CT) scan on admission revealed a large subdural collection with a thin enhancing rim on the left side. Emergency craniotomy revealed a collection of subdural pus, which was irrigated and a catheter was put for continuous drainage. Postoperatively, the patient did well, however, following removal of the catheter, three weeks after the first operation, the subdural empyema was reexpanded with a very thick enhancing rim on CT scan. Ultrasonography also clearly demonstrated the formation of the thick membranes. The large craniotomy was performed and empyema with the outer and inner membranes of 8 mm thick was totally excised. Postoperative CT scan did not show any enhancing rim, indicating that enhancement was caused by newly formed vessels within the membranes per se. This findings are totally different from those observed in the brain abscess in which ring enhancement on CT continues months to years following so-called extracapsular excision of abscess. In the brain abscess, surrounding glial tissue with plenty neovascularization is left intact, even after the operation.
报告了一例包裹性硬脑膜下积脓病例。这名1.5岁男孩因意识障碍加重和惊厥入院。入院前八个月，他因左侧创伤性急性硬膜外血肿接受了开颅手术。在对作为出血源的脑膜中动脉进行凝血后，打开了硬脑膜，但当时未发现皮质损伤。入院时的计算机断层扫描（CT）显示左侧有一个大的硬膜下积液，边缘有薄强化。急诊开颅手术发现硬膜下有脓液，进行了冲洗并放置了导管进行持续引流。术后，患者情况良好，然而，在首次手术后三周拔除导管后，硬膜下积脓复发，CT扫描显示边缘强化非常厚。超声检查也清楚地显示了厚膜的形成。进行了大的开颅手术，完全切除了厚度为8毫米的带有外层和内层膜的积脓。术后CT扫描未显示任何强化边缘，表明强化是由膜内新形成的血管本身引起的。这些发现与脑脓肿中观察到的情况完全不同，在脑脓肿中，即使在所谓的脓肿包膜外切除术后，CT上的环形强化仍会持续数月至数年。在脑脓肿中，即使手术后，周围有大量新血管形成的胶质组织仍保持完整。
