Epidural abscess surgery
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Epidural abscess Microchapters |
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Epidural abscess surgery On the Web |
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American Roentgen Ray Society Images of Epidural abscess surgery |
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Risk calculators and risk factors for Epidural abscess surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]; Anthony Gallo, B.S. [3]
Overview
A combination of surgical drainage and prolonged systemic antibiotics (6-12 weeks, IV followed by PO) is the mainstay of therapy for both intracranial and spinal epidural abscess.[1] Due to the importance of preoperative neurologic status, along with the unpredictable progression of neurologic impairment, for the neurological outcome of the patient, surgical therapy varies depending on the location of the abscess. In intracranial epidural abscess cases, burr hole placement or craniotomy should occur as early as possible. In spinal epidural abscess cases, decompressive laminectomy and debridement of infected tissues should occur as early as possible.[2][3]
Surgery
A combination of surgical drainage and prolonged systemic antibiotics (6-12 weeks, IV followed by PO) is the mainstay of therapy for either intracranial or spinal epidural abscess.[1] Due to the importance of preoperative neurologic status, along with the unpredictable progression of neurologic impairment, for the neurological outcome of the patient, surgical therapy varies depending on the location of the abscess. In intracranial epidural abscess cases, burr hole placement or craniotomy should occur as early as possible. In spinal epidural abscess cases, decompressive laminectomy and debridement of infected tissues should occur as early as possible.[2][3]
Intracranial Epidural Abscess
In intracranial epidural abscess cases, either craniotomy or burr hole placement should occur as early as possible, followed by antibiotic therapy. Craniotomy is the preferred approach to surgical drainage of the infected material from the cranial epidural space. Alternatively, burr hole placement or aspiration through the scalp may be used to access the abscess.[4]
A wide craniotomy with irrigation is the surgical mainstay for intracranial epidural abscess, as it allows a wide exposure of the area, adequate exploration, better evacuation of the infected material and decompression of the underlying cerebral hemisphere, increasing chances of improved outcome.[5][6] A possible complication of craniotomy is the higher probability of damage to the bridging veins during the procedure.
- Burr hole placement
In burr hole placement, a previous imaging study accurately localizes the collection of pus to be evacuated. Burr hole placement is generally performed for intracranial epidural abscess when the patient is considered too frail to undergo craniotomy.[7] It is associated with a higher rate of recurrence of the empyema, compared to craniotomy. Burr hole placement may also lead to secondary injury of the cortex, possibly exacerbating the infection.[7][8]
Spinal Epidural Abscess
In spinal epidural abscess cases, laminectomy, laminotomy, hemilaminectomy, or interlaminar fenestration should occur as early as possible, followed by antibiotic therapy. Patients presenting with spinal epidural abscess require prompt surgical drainage and decompression to avoid long-term neurologic damage. The mainstay of therapy is dependent on the location of the abscess.[4]
Surgical technique in which the lamina of the vertebra is removed or trimmed to widen the spinal canal, creating more space for the spinal nerves.
Surgical technique in which the part of a lamina of the vertebral arch is removed in order to decompress the corresponding spinal cord and spinal nerve roots.
The following video demonstrates L4 laminotomy for surgical evacuation of ventral epidural abscess:[9]
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Surgical technique in which part of the vertebral lamina is removed, allowing for decompression of nerve roots, as well as access to the epidural space. This technique also allows the drainage of abscesses in this space.
- Interlaminar Fenestration
Surgical technique in which a gap is opened between laminae in order to gain access to the epidural space. This technique allows for the drainage of abscesses.
References
- ↑ 1.0 1.1 Grewal, S. (2006). "Epidural abscesses". British Journal of Anaesthesia. 96 (3): 292–302. doi:10.1093/bja/ael006. ISSN 0007-0912.
- ↑ 2.0 2.1 Darouiche, Rabih O. (2006). "Spinal Epidural Abscess". New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 0028-4793.
- ↑ 3.0 3.1 Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM (1992). "Bacterial spinal epidural abscess. Review of 43 cases and literature survey". Medicine (Baltimore). 71 (6): 369–85. PMID 1359381.
- ↑ 4.0 4.1 Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.
- ↑ Agrawal, Amit; Timothy, Jake; Pandit, Lekha; Shetty, Lathika; Shetty, J.P. (2007). "A Review of Subdural Empyema and Its Management". Infectious Diseases in Clinical Practice. 15 (3): 149–153. doi:10.1097/01.idc.0000269905.67284.c7. ISSN 1056-9103.
- ↑ Greenlee JE (2003). "Subdural Empyema". Curr Treat Options Neurol. 5 (1): 13–22. PMID 12521560.
- ↑ 7.0 7.1 Hendaus, Mohammed A. (2013). "Subdural Empyema in Children". Global Journal of Health Science. 5 (6). doi:10.5539/gjhs.v5n6p54. ISSN 1916-9744.
- ↑ Nathoo N, Nadvi SS, Gouws E, van Dellen JR (2001). "Craniotomy improves outcomes for cranial subdural empyemas: computed tomography-era experience with 699 patients". Neurosurgery. 49 (4): 872–7, discussion 877-8. PMID 11564248.
- ↑ Video courtesy of YouTube, Dr. Peyman Pakzaban. https://www.youtube.com/watch?v=Vw2KF9wn6aM Accessed on November 20, 2015