OVER THE years a dispute has smoldered about the management of subdural collections of fluid associated with bacterial meningitis. Some physicians recommend repeated needle aspiration, others favor early surgery, and still others have intimated that, if left alone, the effusions resolve spontaneously.
It has been our custom to drain the fluid by repeated needle taps of the subdural space and reserve neurosurgical intervention for those patients in whom reaccumulation of fluid does not cease within a few weeks. Because stripping of membranes or intracavitary shunting is customarily performed for persisting, large effusions, it has been difficult to know the eventual outcome were they left untreated surgically. It is not mentioned in a recent, extensive review of the subject by Rabe.1
We have had the opportunity to observe the natural history of one such case when the patient's parents refused to permit needle aspiration or surgery.
Report of a Case