# Double-tube burr hole irrigation in the treatment of subdural empyema following chronic subdural hematoma surgery: A case report

## TL;DR

A new surgical method using double-tube burr hole irrigation successfully treated a rare brain infection after a previous surgery.

## Contribution

Introduces a novel double-tube irrigation technique via burr hole surgery for subdural empyema.

## Key findings

- Double-tube irrigation via burr hole surgery resolved a Methicillin-resistant Staphylococcus aureus subdural empyema case.
- The method reduced complications compared to traditional craniotomy and prevented recurrence.
- Continuous irrigation may help manage intracranial pressure and improve treatment safety.

## Abstract

Subdural empyema (SE) following chronic subdural hematoma (CSDH) surgery is an uncommon but serious complication. The best treatment approach, typically a choice between craniotomy and burr hole surgery, is still debated. This case report introduces an innovative method using burr hole surgery with double-tube irrigation, a potentially effective alternative to the more invasive craniotomy.

An 81-year-old male, 48 days post-CSDH surgery, developed SE with Methicillin-resistant Staphylococcus aureus infection. The initial treatment with burr hole drainage was complicated by recurrence, leading to a second procedure with double tubes inserted anteriorly and posteriorly for continuous irrigation therapy. The patient was treated with systemic antibiotics and vancomycin irrigation, resulting in successful resolution without further recurrence.

While burr hole surgery is often deemed less effective than craniotomy for SE, this case demonstrates the potential efficacy of double-tube irrigation via burr hole surgery. This method could be especially beneficial when craniotomy poses significant risks. Continuous irrigation could help in managing intracranial pressure, making the intervention safer. However, further research is needed to refine this technique and establish clear treatment guidelines.

Burr hole surgery with double-tube irrigation emerges as a promising treatment option for SE, especially when craniotomy is not feasible. This approach's success in this case encourages further exploration and study to validate its wider application in similar clinical scenarios.

•Novel Double-Tube Burr Hole Irrigation - New method for Subdural Empyema treatment.•Effective Against Resistant Infections - Successful in Methicillin-resistant Staphylococcus aureus case.•Reduces Complications - Limits risks associated with traditional craniotomy.•Continuous Drainage Strategy - Improves safety and efficacy in SE management.•Case Study Insights - Offers practical implications for patient care.

Novel Double-Tube Burr Hole Irrigation - New method for Subdural Empyema treatment.

Effective Against Resistant Infections - Successful in Methicillin-resistant Staphylococcus aureus case.

Reduces Complications - Limits risks associated with traditional craniotomy.

Continuous Drainage Strategy - Improves safety and efficacy in SE management.

Case Study Insights - Offers practical implications for patient care.