Subdural empyema and epidural abscess in children.

From January 1, 1954, through December 31, 1981, 31 children were treated at The Hospital for Sick Children in Toronto, Ontario, for subdural empyema (22 cases), epidural abscess (6 cases), and infected nidi at both subdural and epidural sites (3 cases). All but four of the children with subdural empyema were from 6 months to 2 years of age or from 12 years to 16 years of age; all children with epidural abscess fitted into the older age group. The subdural empyemas developed from varied sources, but the paranasal sinuses, the ears, and the mastoids processes were predominantly affected. Five subdural empyemas developed following craniotomy or shunt procedures. The epidural abscesses developed mostly from infections in the paranasal sinuses and the middle ears. Two of the combined infections developed from the paranasal sinuses; the third followed craniotomy. The infecting bacteria varied, but were usually Streptococci and were common to both the subdural and epidural sites. The subdural empyemas presented as focal seizures in the older group, and that group of patients was more seriously ill and had greater focal deficit; the mortality rate was 13%. Epidural abscesses only rarely presented with focal deficit, and diagnosis was delayed in most instances; no deaths occurred in this group. Two cases are reported in detail to illustrate the principles and pitfalls of surgical management of these intracranial infections in the pediatric age group.