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Introduction:Intracranial subdural empyema is a medical-surgical emergency that deserves to be better studied in order to propose standardized management. Methods:Our retrospective study included 53 cases hospitalized in the neurosurgery department of the Tunis Military Hospital over a period of 15 years, whose epidemioclinical, therapeutic and evolutionary data we collected and then analyzed.Results:The mean age of patients was 41.5 years. The majority of cases were treated medico-surgically (90.6%) with broad-spectrum antibiotics (100%), followed by trepanation (84.94%) or craniotomy (5.66%). Initial state of consciousness was identified as a statistically significant prognostic factor (p<0.01).Conclusion:The management of pyogenic intracranial subdural empyema in immunocompetent adults requires a multidisciplinary approach. Evacuation by trepanation, combined with appropriate antibiotic therapy, leads to a favorable outcome in most cases.