British Journal of Neurosurgery最新文献

{"title":"Management of brain tumour related epilepsy (BTRE): a narrative review and therapy recommendations.","authors":"Elizabeth Vacher, Miguel Rodriguez Ruiz, Jeremy H Rees","doi":"10.1080/02688697.2023.2170326","DOIUrl":"10.1080/02688697.2023.2170326","url":null,"abstract":"<p><p>Brain Tumour Related Epilepsy (BTRE) has a significant impact on Quality of Life with implications for driving, employment, and social activities. Management of BTRE is complex due to the higher incidence of drug resistance and the potential for interaction between anti-cancer therapy and anti-seizure medications (ASMs). Neurologists, neurosurgeons, oncologists, palliative care physicians and clinical nurse specialists treating these patients would benefit from up-to-date clinical guidelines. We aim to review the current literature and to outline specific recommendations for the optimal treatment of BTRE, encompassing both Primary Brain Tumours (PBT) and Brain Metastases (BM). A comprehensive search of the literature since 1995 on BTRE was carried out in PubMed, MEDLINE and EMCARE. A broad search strategy was used, and the evidence evaluated and graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Seizure frequency varies between 10 and 40% in patients with Brain Metastases (BM) and from 30% (high-grade gliomas) to 90% (low-grade gliomas) in patients with PBT. In patients with BM, risk factors include number of BM and melanoma histology. In patients with PBT, BTRE is more common in patients with lower grade histology, frontal and temporal tumours, presence of an IDH mutation and cortical infiltration. All patients with BTRE should be treated with ASMs. Non-enzyme inducing ASMs are recommended as first line treatment for BTRE, but up to 50% of patients with BTRE due to PBT remain resistant. There is no proven benefit for the use of prophylactic ASMs, although there are no randomised trials testing newer agents. Surgical and oncological treatments i.e. radiotherapy and chemotherapy improve BTRE. Vagus Nerve Stimulation has been used with partial success. The review highlights the relative dearth of high-quality evidence for the management of BTRE and provides a framework for further studies aiming to improve seizure control, quality of life, and indications for ASMs.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"4-11"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9081656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Purely nasal floor mucosa-free graft for reconstruction after endoscopic endonasal transellar approach: an anatomical and clinical analysis.","authors":"Juan M Revuelta Barbero, Roberto M Soriano, Edoardo Porto, David P Bray, Emily Barrow, Oswaldo Henriquez, C Arturo Solares, Gustavo Pradilla","doi":"10.1080/02688697.2023.2202233","DOIUrl":"10.1080/02688697.2023.2202233","url":null,"abstract":"<p><strong>Background/objective: </strong>In this radioanatomical study with clinical correlate, we study a variation of the 'extended nasal floor mucosa' (ENFM) free-graft, the purely nasal floor mucosa (PuNFM) free-graft. The objectives of this study are to evaluate the coverage surface area provided by the PuNFM, study the adequacy of the PuNFM in the reconstruction of endoscopic endonasal approach (EEA) transsellar postoperative defects and compare and evaluate this reconstructive technique with current sellar region reconstruction practices.</p><p><strong>Methods: </strong>Dissections were performed on five cadaveric specimens. PuNFM were harvested bilaterally and the area provided for reconstruction was calculated. Twenty-five consecutive cases of pituitary adenomas resected through an EEA were analyzed to estimate the sellar defect surface area (SDSA) after a transsellar EEA and calculate the area of PuNFM bilaterally.</p><p><strong>Results: </strong>The median cadaveric SDSA was 4.77 cm², with a median left and right side PuNFM area of 5.09 and 5.19 cm², respectively. Clinically, the median SDSA was 5.36 cm², and the total radiological PuNFM surface area was 5.46 cm², with modified Knosp grade >2 tumors having larger SDSA than that of Knosp grade <2 tumors. The PuNFM graft proved to be most effective for covering <i>modified Knosp <</i>2 tumor defects.</p><p><strong>Conclusions: </strong>The PuNFM represents a variation of the ENFM free-graft sellar defect reconstruction technique that provides sufficient surface area to reconstruct the majority of the sellar defects related to transsellar EAA for pituitary adenomas. This technique may positively impact sinonasal function and quality of life. Future prospective clinical studies are needed to verify these findings.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"78-83"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9755048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to evacuation of acute subdural and extradural haematoma: prospective study before and after implementation of a major trauma centre.","authors":"Patrick Holton, Ardalan Zolnourian, Diederik Bulters","doi":"10.1080/02688697.2023.2173723","DOIUrl":"10.1080/02688697.2023.2173723","url":null,"abstract":"<p><p><b>Purpose</b><i>:</i> Patients with Extradural (EDH) and Acute Subdural Haematomas (ASDH) represent a subgroup of head-injured patients that gain the most from timely treatment. While treatment times for head injury overall improved since the introduction of Major Trauma Centres (MTCs), no data exists describing how the time to treatment of EDH and ASDH has changed. We, therefore, compared the evacuation of ASDH and EDH before and after the implementation of a major trauma network.<b>Methods</b><i>:</i> Data was collected prospectively between 1 May 2006 to 31 May 2007 and 1 March 2014 to 31 March 2016. The study was carried out at University Hospital Southampton, designated MTC in 2012. Patients over 18 with ASDH or EDH requiring emergency surgery were included.<b>Results</b><i>:</i> The median time (IQR) for decompression was 4.8h (3.9-6.6) in 2006-7 and 4.4h (3.4-5.9) in 2014-16, <i>p</i> = 0.386. The proportion treated within 4 hours was 32% in 2006-7, and 33% in 2014-16 (<i>p</i> = 1.000). Analysis showed a decrease in time for CT scan (<i>p</i> = 0.01) and acceptance by neurosurgery (<i>p</i> < 0.001). There were increases in time for transferring to hospital (<i>p</i> = 0.005), awaiting operating theatre (<i>p</i> = 0.005), and operative time (<i>p</i> = 0.018).<b>Conclusions</b><i>:</i> Since the introduction of MTCs, there has been no significant reduction in time to treat this select group of patients despite reductions in time to treatment of most other trauma and head-injured patients. This may be because parts of the pathway have improved, but others haven't. It is also possible that while previously head injury was poorly served, resources were prioritised to this group so finding further gains is difficult.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"32-39"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9237861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of two techniques of goal directed fluid therapy in elective neurosurgical patients - a randomized controlled study.","authors":"Ankita Dey, Prasanna Udupi Bidkar, Srinivasan Swaminathan, Manoranjitha Kumari M, Jerry Jame Joy, Mukilan Balasubramanian, Sakshi Bhimsaria","doi":"10.1080/02688697.2023.2173722","DOIUrl":"10.1080/02688697.2023.2173722","url":null,"abstract":"<p><strong>Background: </strong>Goal directed fluid therapy (GDFT) may be a rational approach to adopt in neurosurgical patients, in whom intravascular volume optimization is of utmost importance. Most of the parameters used to guide GDFT are derived invasively. We postulated that the total volume of intraoperative intravenous fluid administered during elective craniotomy for supratentorial brain tumours would be comparable between two groups receiving GDFT guided either by the non-invasively derived plethysmography variability index (PVI) or by stroke volume variation (SVV).</p><p><strong>Methods: </strong>60 ASA category 1, 2 and 3 patients between 18 and 70 years of age were randomized to receive intraoperative fluid guided either by SVV (SVV group; <i>n</i> = 31) or PVI (PVI group; <i>n</i> = 29). The total volume of fluid administered intraoperatively was recorded. Serum creatinine was measured before the surgery, at the end of the surgery, 24 h after surgery and on the fifth post-operative day. Arterial cannulation was performed before induction in all patients. Serum lactate was measured before induction, once in 2 h intraoperatively, at the end of the surgery and 24 h after the surgery. Brain relaxation score was assessed by the surgeon during dural opening and dural closure. Patients were followed up till discharge or death. The duration of mechanical ventilation and the duration of hospital stay was noted for all patients.</p><p><strong>Results: </strong>The volume of fluid given intraoperatively was significantly higher in the SVV group (<i>p</i> = 0.005). The two groups were comparable with respect to serum lactate and serum creatinine measured at pre-determined time intervals. Brain relaxation score was also comparable between the groups. SVV and PVI displayed moderate to strong correlation intraoperatively. The duration of mechanical ventilation and the length of the hospital stay were comparable between the two groups.</p><p><strong>Conclusions: </strong>PVI and SVV are equally effective in guiding GDFT in adults undergoing elective craniotomy for supratentorial brain tumours.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"23-31"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10640530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence and the potential for perioperative delabeling of penicillin allergies for neurosurgery inpatients.","authors":"Melinda Jiang, Antoinette Lam, Lydia Lam, Joshua Kovoor, Joshua Inglis, Sepehr Shakib, William Smith, Amal Abou-Hamden, Stephen Bacchi","doi":"10.1080/02688697.2023.2173724","DOIUrl":"10.1080/02688697.2023.2173724","url":null,"abstract":"<p><strong>Purpose of the article: </strong>Patients with penicillin allergy labels are more likely to have postoperative wound infections. When penicillin allergy labels are interrogated, a significant number of individuals do not have penicillin allergies and may be delabeled. This study was conducted to gain preliminary evidence into the potential role of artificial intelligence in assisting with perioperative penicillin adverse reaction (AR) evaluation.</p><p><strong>Material and methods: </strong>A single-centre retrospective cohort study of consecutive emergency and elective neurosurgery admissions was conducted over a two-year period. Previously derived artificial intelligence algorithms for the classification of penicillin AR were applied to the data.</p><p><strong>Results: </strong>There were 2063 individual admissions included in the study. The number of individuals with penicillin allergy labels was 124; one patient had a penicillin intolerance label. Of these labels, 22.4% were not consistent with classifications using expert criteria. When the artificial intelligence algorithm was applied to the cohort, the algorithm maintained a high level of classification performance (classification accuracy 98.1% for allergy versus intolerance classification).</p><p><strong>Conclusions: </strong>Penicillin allergy labels are common among neurosurgery inpatients. Artificial intelligence can accurately classify penicillin AR in this cohort, and may assist in identifying patients suitable for delabeling.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"40-43"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9297214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The volume-outcome relationship for endoscopic transsphenoidal pituitary surgery for benign neoplasm: analysis of an administrative dataset for England.","authors":"William K Gray, Annakan V Navaratnam, Catherine Rennie, Nigel Mendoza, Tim W R Briggs, Nick Phillips","doi":"10.1080/02688697.2023.2175783","DOIUrl":"10.1080/02688697.2023.2175783","url":null,"abstract":"<p><strong>Background: </strong>Setting minimum annual volume thresholds for pituitary surgery in England is seen as one way of improving outcomes for patients and service efficiency. However, there are few recent studies from the UK on whether a volume-outcome effect exists, particularly in the era of endoscopic surgery. Such data are needed to allow evidence-based decision making. The aim of this study was to use administrative data to investigate volume-outcome effects for endoscopic transsphenoidal pituitary surgery in England.</p><p><strong>Methods: </strong>Data from the Hospital Episodes Statistics database for adult endoscopic transsphenoidal pituitary surgery for benign neoplasm conducted in England from April 2013 to March 2019 (inclusive) were extracted. Annual surgeon and trust volume was defined as the number of procedures conducted in the 12 months prior to the index procedure. Volume was categorised as < 10, 10-19, 20-29, 30-39 and ≥40 procedures for surgeon volume and < 20, 20-39, 40-59, 60-79 and ≥80 procedures for trust volume. The primary outcome was repeat ETSPS during the index procedure or during a hospital admission within one-year of discharge from the index procedure.</p><p><strong>Results: </strong>Data were available for 4590 endoscopic transsphenoidal pituitary procedures. After adjustment for covariates, higher surgeon volume was significantly associated with reduced risk of repeat surgery within one year (odds ratio (OR) 0.991 (95% confidence interval (CI) 0.982-1.000)), post-procedural haemorrhage (OR 0.977 (95% CI 0.967-0.987)) and length of stay greater than the median (0.716 (0.597-0.859)). A higher trust volume was associated with reduced risk of post-procedural haemorrhage (OR 0.992 (95% CI 0.985-0.999)), but with none of the other patient outcomes studied.</p><p><strong>Conclusions: </strong>A surgeon volume-outcome relationship exists for endoscopic transsphenoidal pituitary surgery in England.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"44-51"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10708167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructive hydrocephalus due to an enlarged massa intermedia treated with endoscopic third ventriculostomy.","authors":"Amisha Vastani, Wisam Al-Faiadh, Dan O Chieng, Ata Siddiqui, Cristina Bleil, Rahul Singh, Bassel Zebian","doi":"10.1080/02688697.2022.2159924","DOIUrl":"10.1080/02688697.2022.2159924","url":null,"abstract":"<p><p>The massa intermedia (MI) or interthalamic adhesion (ITA) is a band of tissue connecting the medial surfaces of the thalami and is present in the majority of healthy individuals. Its enlargement as well as its absence have been associated with some pathological states.We describe the first case report of a 3-year-old child presenting with obstructive hydrocephalus in the context of an enlarged massa intermedia. The patient's symptoms abated following an endoscopic third ventriculostomy.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"100-103"},"PeriodicalIF":1.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9086077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of frameless robot-assisted stereoelectroencephalography depth electrode implantation using the neurolocate registration system in paediatric patients.","authors":"Arthur R Kurzbuch, Maria R Scala, Ben Cooper, John Kitchen, Volker Tronnier, Jonathan Ellenbogen","doi":"10.1080/02688697.2024.2441268","DOIUrl":"https://doi.org/10.1080/02688697.2024.2441268","url":null,"abstract":"<p><strong>Background: </strong>We assessed the accuracy and performed a directional analysis of robot-assisted implantation of stereoelectroencephalography (SEEG) depth electrodes in children using the frameless neurolocate 3D registration module.</p><p><strong>Methods: </strong>Thirteen children with epilepsy undergoing stereotactic robot-assisted insertion of SEEG electrodes were included. Six children were operated on with standard frame-based registration while 7 with the use of the frameless neurolocate registration module. Accuracy and directional analysis of orthogonal and oblique electrodes were assessed by calculating the absolute error, the radial error, the angle error, and the Euclidean distance.</p><p><strong>Results: </strong>Of 172 electrodes 89 were implanted in the 6 standard frame-based mode patients and 83 in the 7 neurolocate patients. The overall mean age was 12.2 ± 4.4 years (range 2-17). The mean number of electrodes in each patient was 13.2 ± 2.04 (range 9-17). The median radial error of electrode placement in the neurolocate patients (1.08 mm, [IQR: 1.26]) was significantly less when compared with standard frame-based mode patients (1.49 mm, [IQR 1.25)]; <i>p</i> = 0.04). The same applies to the median angle error which was in the neurolocate group 1.61° [IQR: 1.46] and in the standard frame-based group 2.16° [IQR: 2.09]; <i>p</i> = 0.019. Directional analysis of electrode trajectories in the neurolocate group showed that in the x-axis the median absolute error of orthogonal electrodes (0.4 mm, [IQR: 0.475]) was less when compared with oblique electrodes (0.7 mm, [IQR: 1.2]; <i>p</i> = 0.007). In the standard frame-based mode group in the y-axis, the median absolute error of orthogonal electrodes (0.7 mm, [IQR: 1.3]) was less compared with oblique electrodes (1.25 mm, [IQR: 1.6]; <i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>In paediatric patients, robot-assisted SEEG depth electrode implantation with the non-invasive and easy-to-use frameless neurolocate registration module is a consistent and accurate procedure.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":1.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of clinical examination to distinguish sacroiliac joint pain as a cause of chronic low back pain.","authors":"Vicente Vanaclocha, Pablo Jordá-Gómez, Nieves Saiz-Sapena, Leyre Vanaclocha, Jack Kennedy","doi":"10.1080/02688697.2024.2433492","DOIUrl":"https://doi.org/10.1080/02688697.2024.2433492","url":null,"abstract":"<p><strong>Background: </strong>Despite the availability of safe and effective surgical treatments for chronic SI joint pain, many clinicians find the diagnosis of SI joint pain challenging. Misdiagnosis can lead to misdirected surgery, which has important consequences. The study's goal was to determine whether a combination of clinical examination, joint block, and selected radiographic imaging can distinguish patients with SI joint pain from those with other causes of chronic low back pain.</p><p><strong>Methods: </strong>Prospective diagnostic accuracy study with evaluation of 364 consecutive patients seeking advice in a neurosurgical clinic for chronic low back pain. Participating patients underwent comprehensive clinical examination (medical history items, specific physical examination manoeuvres, and selected radiographic tests) followed by SI joint block. Block was used to confirm or exclude SI joint pain. Logistic regression with LASSO (least absolute shrinkage and selection operator) penalty was used to calculate the accuracy of diagnosis when looking at (1) medical history items only, (2) medical history plus radiographic testing, and (3) medical history, radiographic testing, and physical examination testing.</p><p><strong>Results: </strong>150 patients had a positive response (>50% acute pain relief) to SI joint block, 214 had no response to SI joint block, and 37 had minimal (<50% improvement) in pain. Diagnostic accuracy for SI joint pain was lowest with medical history only (85-86%), slightly higher when radiographic testing was added (87%), and highest when physical examination testing was included (96%).</p><p><strong>Conclusion: </strong>Comprehensive clinical examination (including SI joint block where relevant and selected imaging procedures) is accurate in distinguishing the SI joint from non-SI joint causes of chronic low back pain.</p><p><strong>Trial registration: </strong>https://www.clinicaltrials.gov/study/NCT04381208.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":1.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel minimally invasive irrigating catheter approach for subdural empyema: a case report.","authors":"Matthew T Carr, Roshini Kalagara, Brandon D Philbrick, Christopher P Kellner","doi":"10.1080/02688697.2024.2439288","DOIUrl":"https://doi.org/10.1080/02688697.2024.2439288","url":null,"abstract":"<p><strong>Objective: </strong>To present a new technique for the management of subdural empyema to promote resolution and prevent recurrence.</p><p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-5"},"PeriodicalIF":1.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}