Novel minimally invasive irrigating catheter approach for subdural empyema: a case report

Objective: To present a new technique for the management of subdural empyema to promote resolution and prevent recurrence.

Background: Classic treatment for subdural empyema (SDE) has consisted of antibiotics and surgical treatment with either craniotomy or burrholes. There are still several complications that persist after current treatment, including relatively high rates of morbidity and mortality. In this case report, we present a technique that utilises a novel irrigating-draining catheter to provide a minimally invasive approach for empyema resolution with continuous antibiotic irrigation.

Methods: In this example case, a 24-year-old male presented to the hospital for new onset headache, lethargy, confusion, and extremity tremors. Initial imaging demonstrated a left frontal extra-axial collection, treated with emergent craniotomy for evacuation of subdural empyema. The subsequent hospital course was complicated by the development of bilateral subdural empyemas which were surgically treated with use of novel irrigating-draining catheters.

Results: The patient tolerated the procedure well without any complications. He was subsequently discharged to rehab with no deficits or recurrence at a 4-month follow-up visit.

Conclusions: This minimally invasive novel approach for SDEs can be both safe and effective. Future work should further elucidate the effect of this technique on empyema recurrence and long-term outcomes compared to traditional surgical approaches.