Dr.M.Manoranjitha kumariMadras Institute Of Neurology                      Chennai
Case• 75 years male• Admitted on 6/07/10• c/o pus discharge from prvious burr hole site wound    for 1 week•   Low grade c...
29/09/2002Under LA rightfrontal burrhole,parietal limitedcraniectomy andevacuation ofchronic SDH donePost op CSF leakand s...
27/04/2002Retapping ofchronic SDH29/05/03Granulation tissueexcision from rightparietal burr hole
On examination:Conscious, no neurological deficit, fundus normalPus discharge from frontal burr hole site
Right fronto parietal craniotomy and evacuation of pus and excision of outer membrane
Pus culture – pseudomonas , sensitive to amik, cipro
Post op
DiscussionIncidence66%- prior craniectomy29%-sinusitis, CSOM11- years study -47 patients(retrospective analysis)  JNS-199...
Subdural empyema from chronic SDH 1%50% in patients undergo repeated surgeryCalcification of chronic subdural empyema-r...
• Usually unilateral• Limited by specific boundaries like falx,  tentorium, base of brain and foramen magnum• Behaves expa...
Anaerobic aerobic streptococciFollowing cranial surgery- staph aureusMortality- 18.5%
Thank you
 Subdural empyema
 Subdural empyema
 Subdural empyema
 Subdural empyema
 Subdural empyema
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Subdural empyema

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Subdural empyema

  1. 1. Dr.M.Manoranjitha kumariMadras Institute Of Neurology Chennai
  2. 2. Case• 75 years male• Admitted on 6/07/10• c/o pus discharge from prvious burr hole site wound for 1 week• Low grade continuous fever- 1 week• Head ache – 1 week• No limb weekness, fits, LOC• Non DM TB
  3. 3. 29/09/2002Under LA rightfrontal burrhole,parietal limitedcraniectomy andevacuation ofchronic SDH donePost op CSF leakand secondarysuturing done
  4. 4. 27/04/2002Retapping ofchronic SDH29/05/03Granulation tissueexcision from rightparietal burr hole
  5. 5. On examination:Conscious, no neurological deficit, fundus normalPus discharge from frontal burr hole site
  6. 6. Right fronto parietal craniotomy and evacuation of pus and excision of outer membrane
  7. 7. Pus culture – pseudomonas , sensitive to amik, cipro
  8. 8. Post op
  9. 9. DiscussionIncidence66%- prior craniectomy29%-sinusitis, CSOM11- years study -47 patients(retrospective analysis) JNS-1994 june 34 Intracranial suppuration –a modern decade of post op suppurative empyema, epidural abscess– hlavin et al, university hospital cleveland, ohio
  10. 10. Subdural empyema from chronic SDH 1%50% in patients undergo repeated surgeryCalcification of chronic subdural empyema-rare, till 2006 4 cases( neurosurgery quarterly sep 2006 vol 16 152- 154)
  11. 11. • Usually unilateral• Limited by specific boundaries like falx, tentorium, base of brain and foramen magnum• Behaves expanding mass– increase ICP, cerebral parenchymal penetration, cerebral edema and hydrocephalus due to disruption of blood and CSf flow by elevated ICP• Infarction- thrombosis of cortical veins• Septic venous thrombosis of contiguous veins in subdural empyema
  12. 12. Anaerobic aerobic streptococciFollowing cranial surgery- staph aureusMortality- 18.5%
  13. 13. Thank you
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