Pattisapu J V, Parent A D
Pediatric Neurosurgery, Primary Children's Medical Center, University of Utah School of Medicine, Salt Lake City.
Pediatr Neurosci. 1987;13(5):251-4. doi: 10.1159/000120338.
Subdural empyema is a neurosurgical emergency which is rapidly fatal if not recognized and managed promptly. Most series report a 30-40% mortality, and recommend a craniotomy along with aggressive medical therapy. Between 1978 and 1986, 8 children (2 months to 13 years) with subdural empyemas were diagnosed and treated at our institution, and form the basis for this study. Burr hole and catheter drainage was the treatment of choice in 5 children, while craniotomy was required in 1 case of sinusitis with osteomyelitis. Three infants received multiple subdural taps via the anterior fontanel. All patients responded to surgical intervention and antibiotic therapy. The average follow-up period was 29 months, and 5 children had no developmental delay, decrease in school performance, or impairment of intellectual function. There were no deaths in our series. Although the surgical management of subdural empyemas remains controversial, it appears that burr hole and catheter drainage is sufficient in most cases. With earlier diagnosis, aggressive antibiotic therapy, and timely surgical intervention, the morbidity and mortality of subdural empyemas have significantly diminished in recent years.
硬脑膜下积脓是一种神经外科急症，如果不能及时识别和处理，会迅速致命。大多数系列报道的死亡率为30% - 40%，并建议进行开颅手术及积极的药物治疗。1978年至1986年间，我们机构诊断并治疗了8例（年龄从2个月至13岁）硬脑膜下积脓患儿，本研究以此为基础。5例患儿选择钻孔引流治疗，1例合并骨髓炎的鼻窦炎患儿需要开颅手术。3例婴儿通过前囟进行多次硬脑膜下穿刺。所有患者对手术干预和抗生素治疗均有反应。平均随访期为29个月，5例患儿无发育迟缓、学业成绩下降或智力功能受损。我们的系列病例中无死亡病例。尽管硬脑膜下积脓的手术治疗仍存在争议，但在大多数情况下，钻孔引流似乎就足够了。近年来，随着早期诊断、积极的抗生素治疗和及时的手术干预，硬脑膜下积脓的发病率和死亡率已显著降低。
