Surgical treatment of a patient with purulent frontal sinusitis and falcotentorial empyema

Abstract

Background. Subdural empyemas are accumulation of pus between the dura mater and the arachnoid mater of the brain. They represent 12–25 % of all intracranial purulent‑inflammatory diseases. 70–80 % of them are located convexitaly and 10–20 % in the area of the falx cerebri. A spread of pus on the tentorium cerebellum occurs rare. Without timely treatment, that includes massive therapy with antibiotics and drainage of the subdural empyema, most of the patients die in the result of progression of the secondary purulent meningoencephalitis and dislocation of the brain.Аim. To report the case of subdural empyema of rare localization – in the left part of the interhemispheric fissure and supratentorial space, to demonstrate the effectiveness of prolonged continuous flow drainage in treatment of the subdural empyema in this particular case.Materials and methods. 16‑year‑old patient was admitted into the neurosurgical department of the 1‑st Republican clinical hospital of the Izhevsk city with pronounced general infectious and meningeal syndrome and paresis of the muscles of his right shin and foot. CT scans revealed frontal sinusitis and subdural empyema of the left part of the interhemispheric fissure and the supratentorial space. In addition to intravenous antibacterial therapy with vancomicyn and Meronem bifrontal cranioectomy, debridement of the frontal sinus, obliteration of it’s residual cavity with free muscle graft and external drainage of the subdural empyema with following continuous irrigation during 6 days after surgery had been performed. At the time of discharge from the neurosurgical department 16 days after the operation complete regress of the general infectious and meningeal syndrome was observed.Results. On control examination 44 days after the surgery the patient’s condition was normal and he had no neurolog ical deficit. On the series of MRI scans preformed 6 months latter, after the cranioplasty, no remnants of the subdural empyema were revealed.Conclusions. This clinical case demonstrates the effectiveness of the prolonged continuous flow drainage in combination with systemic antobioticotherapy and elimination of the primary source of infection within the frontal sinus in treatment of the large and deeply situated subdural empyema of rare falcotentorial localization.