Loembe P M, Idoundou-Antimi J S, Kouakou M O, Mwanyombet-Ompounga L, Kouna P, Assengone-Zeh Y
Service de neurochirurgie, Fondation Jeanne-Ebori, Líbreville, Gabon.
Sante. 1997 May-Jun;7(3):173-6.
Intracranial, and especially subdural, empyemas are a medical emergency usually requiring surgical intervention. We suggest herein a protocol for their management in areas where CT is not yet available.
16 patients with supratentorial empyemas (6 epidural abscesses, 6 subdural empyemas and 4 with both) diagnosed by surgical intervention in our department between 1986 and 1995 were studied. The etiological features were frontal sinusitis (7 cases), mastoid infection (1), trauma (5), previous operations (2) and unknown (1). Three patients were in a normal state of consciousness, 8 were drowsy and 5 were in a coma. Antibiotic treatment was empirical in 6 patients and specific in 10 patients. Surgical treatment was by multiple burr holes in 9 patients, small craniotomies in 3 patients, major craniotomies in 3 patients and by exploration of a previous craniotomy in 1 patient. A catheter was used for drainage in 12 patients.
Average follow-up was 2.7 years. Two patients died, 3 had seizures and 11 were able to lead a normal life.
We recommend a regime of 2 or 3 antibiotics as an initial treatment. A number of factors including ecological environment, availability of drugs and financial circumstances of each patient should be considered when determining the treatment to be used. Surgical techniques vary according to the surgeon's experience. In our medical centre, drainage via burr-holes is the initial method of treatment for supratentorial empyemas.
颅内积脓，尤其是硬膜下积脓，是一种通常需要手术干预的医疗急症。我们在此提出一种在尚无CT设备的地区对其进行治疗的方案。
对1986年至1995年间在我科经手术干预确诊的16例幕上积脓患者（6例硬膜外脓肿、6例硬膜下积脓和4例两者皆有）进行研究。病因特征为额窦炎（7例）、乳突感染（1例）、外伤（5例）、既往手术史（2例）及病因不明（1例）。3例患者意识正常，8例嗜睡，5例昏迷。6例患者采用经验性抗生素治疗，10例采用针对性抗生素治疗。9例患者采用多处钻孔引流术，3例采用小骨窗开颅术，3例采用大骨瓣开颅术，1例采用既往开颅术探查。12例患者使用导管引流。
平均随访2.7年。2例患者死亡，3例出现癫痫发作，11例能够正常生活。
我们建议初始治疗采用2种或3种抗生素。在确定治疗方案时应考虑多种因素，包括生态环境、药物可及性及每位患者的经济状况。手术技术因外科医生的经验而异。在我们的医疗中心，钻孔引流是幕上积脓的初始治疗方法。
