Most patients with chronic subdural hematoma (CSDH) have a history of craniocerebral trauma.Avulsion of intracranial pontine vein is the main pathogenesis after craniocerebral injury.CSDH drilling and drainage is the most widely used surgical method,with low recurrence and mortality rate.However,the postoperative complication of subdural pyometra is extremely rare,which leads to high mortality and disability rate and thus representing a very challenging disease in trauma surgery.Old age,diabetes mellitus,drainage with foreign body,craniocerebral surgery,open wound,chronic systemic infectious diseases (sinusitis,otitis media,abdominal abscess,lung infection,urinary tract infection),tumor or immune deficiency diseases are all the high risk factors.This paper reviews the pathogenesis,pathogenic bacteria,clinical manifestations,auxiliary examination,treatment and prognosis of subdural empyema after CSDH drilling and drainage in recent years,and provides suggestions for clinical management.

Abstract Rationale: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. However, complicated subdural empyema rarely occurs after trepanation and drainage of chronic subdural hematoma. Patient concerns: A male patient (77 years old) was admitted to the hospital on the 2nd day of fever after an undergoing a “trepanation and drainage of chronic subdural hematoma” operation at a local hospital. After admission, the patient was treated with an emergency operation in which a subdural abscess was diagnosed and then administered antibiotics after the operation. Diagnosis: According to the clinical manifestations, intraoperative findings of imaging examination and the results of pus culture, the diagnosis was subdural empyema. Intervention: We surgically removed the subdural empyema. Postoperative antibiotics were administered according to the results of bacterial culture. Outcomes: At 3 months after the operation, the patient returned to the hospital for reexamination and was found to have achieved a good recovery and good self-care. Lessons: Subdural empyema after trepanation and drainage of chronic subdural hematoma is a very rare and severe disease. Early diagnosis and operative intervention as well as the intravenous administration of antibiotics can improve the prognosis of patients and enhance their quality of life.