Epidural abscess surgery
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Epidural abscess Microchapters |
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Diagnosis |
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Treatment |
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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]
Overview
An epidural abscess is a rare suppurative infection of the central nervous system, a collection of pus localised in the epidural space lying outside the dura mater, which accounts for less than 2% of focal CNS infections. [1] It may occur in two different places: intracranially or in the spinal canal. Due to the fact that the initial symptoms and clinical characteristics are not always identical and are similar to other diseases, along with the fact that they are both rare conditions, the final diagnosis might be delayed in time. This late diagnosis comes at great cost to the patient, since it is usually accompanied by a bad prognosis and severe complications, with a potential fatal outcome. According to the location of the collection, the abscess may have different origins, different organisms involved, symptoms, evolutions, complications and therapeutical techniques. [2] The treatment of epidural abscess focuses in two main aspects: reduction of the inflammatory mass; and eradication of the responsible organism. These goals can be reached through a combination of therapeutical approaches, including: aspiration, drainage and antibiotic therapy. An early surgical decompression and drainage, followed by an aggressive antibiotic treatment is the ideal procedure to increase the chances of a better outcome.
Surgery
Several studies have reached the conclusion that the best approach to therapy of epidural abscess, either intracranial or spinal, is a combination of surgical drainage along with prolonged systemic antibiotics (6-12 weeks, IV followed by PO). [3] Due to the importance of preoperative neurologic status, along with the unpredictable progression of neurologic impairment, for the neurological outcome of the patient, decompressive laminectomy and debridement of infected tissues, in the case of SEA, and burr hole placement or craniotomy, in the case of IEA, should take place as early as possible. [4][5]
Intracranial Epidural Abscess
The standard treatment of intracranial epidural abscess consists in surgical drainage, followed by antibiotic therapy. The surgical drainage of the infected material in the cranial epidural space may be performed by several techniques, namely: craniotomy or craniectomy, which are the preferred approaches, or by burr hole placement or aspiration through the scalp.[6]
Spinal Epidural Abscess
Patients presenting with spinal epidural abscess complicated with neurologic deficits require prompt surgical drainage and decompression to avoid long-term neurologic damage. Depending on the location and extent of the abscess, the surgical procedure might be: laminectomy, hemilaminectomy or interlaminar fenestration. One approach to the abscess is surgery with decompression of the most affected area of the spinal cord, with removal of the pus or granulation tissue. [7]
Below is a video demonstrating L4 laminotomy for surgical evacuation of ventral epidural abscess
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Video curtesy of Dr. Peyman Pakzaban Peyman Pakzaban (youtube)
References
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ Danner, R. L.; Hartman, B. J. (1987). "Update of Spinal Epidural Abscess: 35 Cases and Review of the Literature". Clinical Infectious Diseases. 9 (2): 265–274. doi:10.1093/clinids/9.2.265. ISSN 1058-4838.
- ↑ Grewal, S. (2006). "Epidural abscesses". British Journal of Anaesthesia. 96 (3): 292–302. doi:10.1093/bja/ael006. ISSN 0007-0912.
- ↑ Darouiche, Rabih O. (2006). "Spinal Epidural Abscess". New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 0028-4793.
- ↑ 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.
- ↑ 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.
- ↑ 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.