INTRACRANIAL SUPPURATION - A MODERN DECADE OF POSTOPERATIVE SUBDURAL EMPYEMA AND EPIDURAL ABSCESS

A RETROSPECTIVE STUDY of subdural empyema and epidural abscess spannin g 11 years and encompassing 41 patients was performed, demonstrating t hat the clinical characteristics of intracranial suppuration have chan ged over time. Sinusitis and otitis media, previously the predominant etiologies, were predisposing factors in only 29% of patients. A prior craniotomy had been performed in 66% of cases and was the most common risk factor for abscess development, The postoperative patients were subjected to detailed analysis. Patients who had undergone a prior cra niotomy were notable for the following features: older age, lack of fe ver, evidence of wound infection, frequent false-negative computed tom ographic scans, and a high percentage of Gram negative aerobic organis ms or skin flora as pathogens. The population at highest risk for absc ess development ranged from 50 to 60 years old, older than in previous series. Older age and an advanced degree of encephalopathy were indic ative of a poor prognosis. Patients with subdural empyema had a worse prognosis as well. Hyponatremia was a frequent complicating factor. A much greater percentage of Gram-negative aerobic bacteria were isolate d than in previous studies. Computed tomographic scans, half of which were performed with intravenous contrast material, were nondiagnostic in 30% of patients. The mortality rate was 18.5%, and delay in treatme nt correlated with increased risk of poor outcome, All patients were t reated with a craniotomy. Repeated operations were required in three p atients and were associated with the development of intraparenchymal a bscess.