Intracranial subdural empyema is a rare form of suppuration in Europe and North America, and is a potentially dangerous but treatable disease. The clinician must be aware that this complication requires prompt diagnosis and urgent neurosurgical intervention. The etiology, pathology, bacteriology, clinical features, diagnostic procedures and the different surgical approaches to this disease are reviewed. It seems that there is no single best surgical approach for treating subdural empyema, however, multiple burr holes drainage and craniotomy remain the most frequently used approaches.