Post-traumatic rhinogenic subdural empyema complicated with brain abscess caused by prevotella species: a case report of dual-drainage strategy with bone flap preservation

Abstract Background Post-traumatic rhinogenic intracranial infections are rare but life-threatening complications. Concurrent subdural empyema and brain abscess present significant diagnostic and therapeutic challenges. Case Presentation : We report a 19-year-old male patient who developed right frontoparietal subdural empyema complicated with brain abscess following facial trauma and acute exacerbation of chronic sinusitis. The patient presented with fever and altered consciousness (GCS 10). MRI revealed multi-compartment intracranial abscesses and sinus involvement. Bacterial culture identified Prevotella species. Considering the multi-compartment distribution of infection and the specific risks of bone flap management in active infection, we adopted a bone flap-preserving “dual-drainage” strategy combining neurosurgical burr hole drainage with endoscopic sinus surgery. Postoperative treatment included continuous vancomycin irrigation through drainage catheters combined with intravenous meropenem. The patient showed progressive neurological improvement and was discharged with favorable functional outcome on postoperative day 13. Conclusion This case demonstrates that for multi-compartment post-traumatic rhinogenic intracranial infections, a bone flap-preserving “dual-drainage” minimally invasive strategy combined with multidisciplinary collaboration may be superior to conventional craniotomy.