Bok A P, Peter J C
Department of Neurosurgery, Groote Schuur Hospital, Cape Town, South Africa.
J Neurosurg. 1993 Apr;78(4):574-8. doi: 10.3171/jns.1993.78.4.0574.
Ninety patients with subdural empyema were treated in the period after computerized tomography (CT) became available (1979 to 1991). Males predominated by a ratio of 2:1, and 40 patients were between 11 and 20 years old. The site of origin was the paranasal air sinuses in 53 patients, the middle ear in 19, and a superficial infection in eight; the source of infection was not known in 10. The most common clinical presentation was headache, fever, neck stiffness, seizures, or periorbital swelling; only seven patients had status epilepticus. While the erythrocyte sedimentation rate and white blood cell count were invariably elevated, the cerebrospinal fluid showed nonspecific pleocytosis in the 60 patients who underwent lumbar puncture. The definitive preoperative diagnosis was made by contrast-enhanced CT in all cases. Surgical treatment was by multiple burr holes in 37 patients, burr holes and small craniectomies in 33, burr holes with catheter drainage in seven, and a large craniotomy in 12. One patient was treated without surgery. The mortality rate was 7.7%, with 86% making a good recovery. These results compare favorably with those reported in other studies using craniotomy alone, and suggest that burr holes should not be disregarded as a method of treating subdural empyema where contrast-enhanced CT facilities are available.
在计算机断层扫描（CT）问世后（1979年至1991年），对90例硬膜下积脓患者进行了治疗。男性患者居多，男女比例为2:1，40例患者年龄在11至20岁之间。感染源为鼻窦的有53例，中耳的有19例，浅表感染的有8例；10例感染源不明。最常见的临床表现为头痛、发热、颈部强直、癫痫发作或眶周肿胀；仅7例患者出现癫痫持续状态。虽然红细胞沉降率和白细胞计数均始终升高，但在接受腰椎穿刺的60例患者中，脑脊液显示非特异性细胞增多。所有病例术前均通过增强CT做出明确诊断。手术治疗方面，37例患者采用多个钻孔，33例采用钻孔加小骨瓣切除术，7例采用钻孔加导管引流，12例采用大骨瓣开颅术。1例患者未接受手术治疗。死亡率为7.7%，86%的患者恢复良好。这些结果与其他仅使用开颅术的研究报告相比更具优势，表明在有增强CT设备的情况下，钻孔不应被视为治疗硬膜下积脓的一种可忽视的方法。
