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Subdural empyema (SDE) is generally a disease of children and adolescents. The lack of specific findings in a child with SDE may lead to a rapidly fatal outcome as the result of a delay in diagnosis and treatment. The advent of newer imaging modalities, such as magnetic resonance imaging (MRI), and antibiotics has resulted in improved outcomes. This article reviews the current strategies for diagnosis and treatment of this condition. Current articles on SDE were reviewed and summarized. An overview is presented, followed by an emphasis on causation, pathogenesis, patient presentation, differential diagnosis, and treatment. The approach currently used at this institution for the management of pediatric patients with SDE is also described. Sinus and ear infections, trauma, intracranial surgery, and dental caries account for most cases of SDE. The clinician must be highly suspicious of SDE in the febrile child with neurologic signs and a recent history of ear or paranasal sinus infections. Aerobic and anaerobic streptococci are the most frequent causative organisms cultured from this infection. No definitive guidelines exist regarding duration of treatment, but most series report 2 to 6 weeks of intravenous antibiotics. Arguments have persisted over the use of burr hole drainage versus craniotomy for evacuation of subdural pus. The type of surgical procedure has little impact on the outcome, provided that it is performed early and allows for complete evacuation of the pus. The preoperative neurologic status, age of the patient, and time from presentation to treatment are the most significant determinants of outcome. Early diagnosis, early evacuation, and early use of antibiotics are the fundamental principles of SDE management. [ABSTRACT FROM AUTHOR]

SUMMARY: Over the last decade, neurosurgeons have become increasingly reliant on image guidance to perform surgery more safely, efficiently, and cost-effectively. Neuronavigational systems are either frame based or frameless and rely on the acquisition of computed tomography or magnetic resonance (MR) imaging (MRI) scans that are obtained either a few days or immediately before surgery to generate a 3-dimensional coordinate set. Unfortunately, neuronavigational systems do not allow the neurosurgeon to adjust for dynamic changes that occur during surgery such as brain shift. More recently, intraoperative MR (iMR) imaging systems have been developed and implemented to treat neurosurgical diseases. These systems consist of a low-field (0.12 or 0.23 T), midfield (0.5 T), or high-field (1.5 T) MR imaging scanner located in an environment that allows general anesthesia to be administered. The main advantage of iMR imaging is the excellent soft tissue discrimination and 3-dimensional visualization of the operative site. Enhanced visualization of an intracranial target allows for a safe surgical trajectory to be chosen that avoids critical structures, the determination of the extent of the tumor resection, and the exclusion of intraoperative hemorrhage. All iMRI systems can provide the neurosurgeon with basic T1- and T2-weighted imaging sequences. High-field MRI systems can also perform advanced functional capabilities such as MR spectroscopy, functional MR imaging, MR venography (MRV), MR angiography (MRA), chemical shift imaging, and diffusion-weighted imaging, however. These MR imaging sequences can provide additional information that may facilitate the success of the operative procedure. Identifying critical vascular structures with MRV and MRA may prevent their inadvertent injury during surgery. Locating an area of elevated choline level within a tumor at the time of biopsy may enhance the diagnostic yield of the procedure. Mapping out areas of neurologic function may influence the choice of the surgical approach to a tumor. In addition to using iMRI to resect tumors, it can be used for placement of deep brain stimulators for Parkinson disease, for the performance of psychosurgery for obsessive-compulsive disorder, or for the treatment of common neurosurgical diseases such as hydrocephalus. [ABSTRACT FROM AUTHOR]