Interdisciplinary Neurosurgery (Mar 2022)
Clinico-radiological assessment and therapeutic management of intracranial suppurations: Bicentric series of 43 cases with literature review
Abstract
Background: Intracranial suppurations (ICSs) are purulent collections of infectious origin. Many therapeutic attitudes have been described. Management has not really been the subject of consensus. Purpose: Study the epidemiological, clinical, and paraclinical features of ICSs and assess the clinical, radiological and postoperative outcomes according to the different therapeutic modalities. Patients and methods: Our retrospective, descriptive study including 43 cases of ICSs treated in the Neurosurgery department of the UHC Habib Bourguiba and Traumatology and Major Burns Center of Ben Arous-Tunisia, over a period of 7 years from 2012 to 2018. All epidemiological, etiological, clinical, radiological, biological, therapeutic and evolutionary parameters were studied. Results: The mean patients’age was 32.35 years with a sex ratio of 4.37. Locoregional infections accounted for 60.46% of aetiologies. Clinical signs found were infectious syndrome in 79.07% and intracranial hypertension in 62.70%. Neuroimaging made diagnosis in 30 cases of abscess and 13 cases of empyema. Predilection site was supratentorial in 90% of abscess and in 92.30% of empyema. Streptococci were isolated in 75% of abscess and in 4 cases of empyema. All patients received broad-spectrum antibiotics. Abscess aspiration was performed in 20 cases and excision in 17 cases. Evacuation of empyema by trepanation was performed in 7 patients and through craniotomy in 7 cases. Outcomes were favorable in 23 cases of abscess and 11 cases of empyema. Conclusion: ICSs are a topical pathology in various countries where management is multidisciplinary. Outcomes are favorable in more than 80%, improved by early treatment. Clinico-radiological monitoring during follow-up remain essential.
