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Infantile Supratentorial Subdural Empyema Managed By Percutaneous Aspiration: An Outcome Study In A Nigerian City

Okezie Obasi Kanu, Christopher I. Esezobor, Omotayo A. Ojo, Chinyere N. Asoegwu, Chinenye Nnoli, Yusuf D. Dawang, Edamisan Temiye.

Abstract
Background:
Subdural empyema (SDE), a common neurosurgical emergency in developing countries, accounts for 15%-20% of localized pediatric intracranial infections. In regions where modern diagnostic tools are scarce and inaccessible, detection of SDE may be delayed with subsequent poor outcome. Percutaneous subdural aspiration in patients with open anterior fontanel may be the only surgical option in resource-poor regions of the world. This review focuses on the outcome, including neurological outcome of these children.
Methods
Clinical charts of children with SDE and treated by percutaneous subdural tap between February 2006 and August 2014 were reviewed. Demographic, clinical, radiological, bacteriological parameters and outcome data were analyzed.
Results
Forty-five children with a mean age of 10.6 + 6.2 months (range: 2-17 months) and followed up for a median duration of 16.4 (include range) months were included. The most frequent clinical features were enlarged head circumference, fever, focal neurologic deficits and altered level of consciousness. Diagnosis of SDE was confirmed using trans-fontanel ultrasound scan in 32 (71.1%) children, computerized tomography in 12 (26.7%) and magnetic resonance imaging in one (2.2%). SDE was unilateral in 73.3% and bilateral in 26.7%. In 23 (51.1%) children with a positive culture Staphylococcus aureus (n=10), anaerobes (n=7), Escherishia coli and Haemophilus influenza (n=6 each) were the most common organisms. Forty-three children (95.6%) survived, 36 of which had good Glasgow outcome score. Seven children still had moderate deficits at 3 months.
Conclusion
Treatment of SDE in young children with patent fontanel using percutaneous subdural tap has good hospital and neurological outcome.

Key words: Infantile subdural empyema; meningitis; outcome; percutaneous aspiration; surgical treatment. Nigeria


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