Sinogenic Subdural Empyema in a Ten-Year-Old Boy with Sickle Cell Anemia

Objective: Sinogenic subdural empyemaremains a neurosurgical emergency, even in the antibiotic era. Sickle celldisease is one of the most frequent hereditary diseases, with an incidence of around 4 in 1000 newborns, which necessitates special considerations before a neurosurgical intervention. Case Description: The case of a 10-year-old boy with sickle celldisease type HbSC is reported, who presented with meningitis about ten days after a nasal sinusitis. CT and MRI showed subdural empyemaand immediate intravenous antibiotic treatment was started. The patient received partial exchange transfusion. Craniotomyallowed evacuation of empyemaand repairment of a frontobasal dural defect. Endoscopic evacuation of the paranasal sinuseswas done in the same anesthesia. After initial good recovery, the patient developed right sided paresiswith epileptic seizuresa few days later. CT scan revealed three distant empyemarecurrencies which were evacuated in a second neurosurgical intervention. The child recovered without neurologic deficit, and control MRI examinations three and twelve months after surgery found frontal and parietal dural thickening as sequelae. Conclusion: Urgent neurosurgical interventions in the presence of sickle cell anemiarequire special anesthesiologicpreparations. An immediate, multidisciplinary approach can lead to a good outcome in these life-threatening situations.