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 patient may suffer from the progression of hydrocephalus with symptoms of headaches, agitation, and obtundation The development of cranial nerve dysfunction necessitates neurosurgical intervention for decompression of the posterior fossa with potential removal of hemorrhage Venous Infarcts Venous infarcts are generally seen after craniotomy, especially if the venous sinuses are involved in the surgical field Repair of dural sinus lacerations or prolonged compression of a sinus by an extrinsic force places the patient at risk of venous sinus thrombosis and infarction Presenting symptoms include headache, nausea, vomiting, and seizures, often resembling those caused by pseudotumor cerebri Cerebral venous thrombosis and/or dural sinus thrombosis can lead to venous infarction This infarction may present as hemorrhage and often involves the subcortical white matter CT scan reveals hemorrhage that may traverse the typical arteriovascular boundaries The component of hemorrhage or significant mass effect resulting from cerebral edema becomes a neurosurgical emergency Evacuation of the clot may be necessary, as may decompressive craniectomy Suggested Readings and Key References Blumstein H, Schardt S Utility of radiography in suspected ventricular shunt malfunction J Emerg Med 2009;36(1):50–54 Brown RD Jr, Weibers DO, Forbes GS Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions J Neurosurg 1990;73(6):859–863 Carney N, Totten AM, O’Reilly C, et al Guidelines for the management of severe traumatic brain injury, fourth edition Neurosurgery 2017;80(1):6– 15 Chandrasenan J, Klezl Z, Bommireddy R, et al Spondylodiscitis in children J Bone Joint Surg Br 2011;93(8):1122–1125 Chi JH, Fullerton HJ, Gupta N Time trends and demographics of deaths from congenital hydrocephalus in the United States: national center for health Statistics data, 1979 to 1998 J Neurosurg 2005;103(2 Suppl):113– 118 Cruz J, Minoja G, Okuchi K, et al Successful use of the new high-dose mannitol treatment in patients with Glasgow coma scale scores of and bilateral abnormal papillary widening: a randomized trial J Neurosurg 2004;100(3):376–383 Dayer R, Alzahrani MM, Saran N, et al Spinal infections in children: a multicentre retrospective study Bone Joint J 100-B(4):542–548 Diringer MN, Videen TO, Yundt K, et al Regional cerebrovascular and metabolic effects of hyperventilation after severe traumatic brain injury J Neurosurg 2002;96(1):103–108 Domenicucci M, Mancarella C, Santoro Get al Spinal epidural hematomas: personal experience and literature review of more than 1000 cases J Neurosurg Spine 2017;27(2):198–208 Garton HJL, Kestle JR, Drake JM Predicting shunt failure on the basis of clinical symptoms and signs in children J Neurosurg 2001;94(2):202– 210 Gleeson H, Wiltshire E, Briody J, et al Childhood chronic recurrent multifocal osteomyelitis: pamidronate therapy decreases pain and improves vertebral shape J Rheumatol 2008;35(4):707–712 Gore PA, Maan H, Chang S, et al Normobaric oxygen therapy strategies in the treatment of postcraniotomy pneumocephalus J Neurosurg 2008;108(5):926–29 Goyal P, Mangla R, Gupta Set al Pediatric congenital cerebrovascular anomalies J Neuroimaging 2019;29(2):165–181 Hadjipavlou AG, Korovessis PG, Kakavelakis KN Spine infection: medical versus surgical treatment options In: Vaccaro AR, Eck JC, eds Controversies in Spine Surgery New York: Thieme; 2010:250–260 Hasbun R, Wootton SH, Rosenthal N, et al Epidemiology of meningitis and encephalitis in infants and children in the United States, 2011–2014 Pediatr Infect Dis J 2019;38(1):37–41 Hofmann SR, Kapplusch F, Girschick HJ, et al Chronic recurrent multifocal osteomyelitis (CRMO): presentation, pathogenesis, and treatment Current Osteoporosis Reports 2017;15(6):542–554 Hoit DA, Schirmer CM, Weller SJ, et al Angiographic detection of carotid and vertebral arterial injury in the high-energy blunt trauma patient J Spinal Disord Tech 2008;21(4):259–266 Hospach T, Langendoerfer M, von Kalle T, et al Spinal involvement in chronic recurrent multifocal osteomyelitis (CRMO) in childhood and effect of pamidronate Eur J Pediatr 2010;169(9):1105–1111 Iskandar BJ, McLaughlin C, Mapstone TB, et al Pitfalls in the diagnosis of ventricular shunt dysfunction: radiology reports and ventricular size Pediatrics 1998;101(6):1031–1036 Jansson A, Renner ED, Ramser J, et al Classification of non-bacterial osteitis: retrospective study of clinical, immunological and genetic aspects in 89 patients Rheumatology (Oxford) 2007;46(1):154–160 Kahle KT, Kulkarni AV, Limbrick DD Jr, et al Hydrocephalus in children Lancet 2016;387(10020):788–799 Kim TY, Stewart G, Voth M, et al Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department Pediatr Emerg Care 2006;22(1):28–34 Koroknay-Pál P, Lehto H, Niemelä M, et al Long-term outcome of 114 children with cerebral aneurysms: clinical article J Neurosurg Pediatr 2012;9(6):636–645 Kumar R, Singhi S, Singhi P, et al Randomized controlled trial comparing cerebral perfusion pressure-targeted therapy versus intracranial pressuretargeted therapy for raised intracranial pressure due to acute CNS infections in children Crit Care Med 2014;42(8):1775–1787 Labauge P, Brunereau L, Laberge S, et al Prospective follow-up of 33 asymptomatic patients with familial cerebral cavernous malformations Neurology 2001;57(10):1825–1828 Lasjaunias P, Wuppalapati S, Alvarez H, et al Intracranial aneurysms in children aged under 15 years: review of 59 consecutive children with 75 aneurysms Childs Nerv Syst 2005;21(6):437–450 Lee JY, Ebel H, Ernestus RI, et al Various surgical treatments of chronic subdural hematoma and outcome in 172 patients: is membranectomy necessary? Surg Neurol 2004;61(6):527–528 Lehnert BE, Rahbar H, Relyea-Chew A, et al Detection of ventricular shunt malfunction in the ED: relative utility of radiography, CT, and nuclear imaging Emerg Radiol 2011;18(4):299–305 Mater A, Shroff M, Al-Farsi S, et al Test characterstics of neuroimaging in the emergency department evaluation of children for cerebrospinal fluid shunt malfunction CJEM 2008;10(2):131–135 ... Stewart G, Voth M, et al Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department Pediatr Emerg Care 2006;22(1):28–34 Koroknay-Pál P, Lehto H, Niemelä M,... of postcraniotomy pneumocephalus J Neurosurg 2008;108(5):926–29 Goyal P, Mangla R, Gupta Set al Pediatric congenital cerebrovascular anomalies J Neuroimaging 2019;29(2):165–181 Hadjipavlou AG,... Pitfalls in the diagnosis of ventricular shunt dysfunction: radiology reports and ventricular size Pediatrics 1998;101(6):1031–1036 Jansson A, Renner ED, Ramser J, et al Classification of non-bacterial