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the patient can be afebrile. The treatment of brain abscess is the same as
that of any other abscess: incision and drainage. This procedure is
diagnostic as well. Needle aspiration combined with the administration of
broad-spectrum antibiotics will clear approximately 80% to 85% of
abscesses. The remainder will require craniotomy for complete cure. If
infection extends to the craniotomy flap; then reoperation, bone flap
removal, and drainage of the abscess should be carried out for definitive
therapy.
Subdural Empyema. Subdural empyema is rare after craniotomy but may
follow burr hole drainage of a chronic subdural hematoma. This entity is
also marked by neurologic deterioration, with the development of focal
signs of hemiparesis, seizures, or both. These neurologic findings are
related to mass effect from edema that unlike subdural hematomas, is out of
proportion to the volume of fluid in the subdural space. It can also be
further complicated by venous thrombosis and infarction. Diagnosis by CT
scan may be difficult, and a high index of suspicion is required. However, a
parafalcine subdural collection, which can be seen on CT scan, is
pathognomonic for subdural abscess. Treatment with drainage and broadspectrum antibiotics is the gold standard. Drainage may be accomplished by
reoperation or burr holes, and many surgeons recommend placing subdural
catheters for irrigation of this space with antibiotic solutions such as
concentrated bacitracin.
Infarctions
Arterial Infarcts. Arterial infarct is a rare complication after craniotomy but
may occur if there has been substantial intraoperative manipulation of
cerebral vessels. Clinically, the patient will usually exhibit focal neurologic
deficits. If a large area or bilateral areas of the brain are involved, the
patient may experience a global decrease in level of consciousness and
more extensive neurologic deficits.
Cerebellar infarction, specifically, incurs a higher risk of obstructive
hydrocephalus due to occlusion of the fourth ventricle. Symptoms and signs
related to cerebellar dysfunction, such as dizziness, vertigo, nausea,

vomiting, truncal ataxia, nystagmus, and dysarthria, appear first. Next, the