Epidural abscess future or investigational therapies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

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 medical and surgical approaches. An early surgical decompression and drainage, along with an aggressive antibiotic treatment is the ideal procedure to increase the chances of a better outcome.

Currently there are diagnostic and therapeutical procedures being studied or tested in order to, not only improve the diagnosis of epidural abscess, but also to treat it, in the less invasive way possible:

• Magnetic Resonance Imaging-Guided Stereotactic Surgery – has been used successfully in draining an empyema involving the tentorium cerebelli, in a more precise way than the burr hole procedure and less invasively that the craniotomy. ^[3]
• Hollow screws – have been supported by specialists, for the diagnosis and treatment os subdural empyema, particularly in situations when CT and MRI studies are inconclusive. ^[4][5] Considering that the subdural empyema and the epidural abscess are two examples of focal CNS infections, this technique may be applied to the epidural abscess as well.