Decompressive craniectomy for encephalitis with brain herniation: case report and review of the literature

Abstract

Based on this literature review, we consider that, due to the specific characteristics of infectious encephalitis, especially in case of viral infection, decompressive craniectomy is probably an effective treatment when brain stem compression threatens the course of the disease. In patients with viral encephalitis, better prognosis can be expected when surgical decompression is used than when only medical treatment is provided.

Analysis of Fulminant Cerebral Edema in Acute Pediatric Encephalitis

“…13e16 In a literature review of decompressive craniectomy for the treatment of encephalitis-related brain edema, the authors concluded that brainstem compression is probably an important sign that the procedure should be performed. 19 In the current study, 80% of the patients had fulminant cerebral edema before they were 8 years old. The most common presenting neurological symptoms were an altered level of consciousness (72%), vomiting (60%), and headache (48%).…”

“…14e16 A literature review of 43 patients who underwent decompressive craniectomy for encephalitis-related brain edema reported a mortality rate of 4% and a rate of good recovery of 81%. 19 Although this result is encouraging, the small number of patients limits the conclusions that can be drawn. In our study, in addition to antiviral treatment, all patients received hyperosmolar therapy prior to showing signs of fulminant cerebral edema.…”

Decompressive Craniectomy for Viral Encephalitis: Two Case Reports

“…Intracranial hypertension tends to appear slowly, progressing with cerebral inflammation, with its peak occurring from days to weeks after the onset of the symptoms. 5,6,11,12 Clinically, in addition to the focal signs, the disease is manifested by fever with headache, sometimes associated with changes in the level of consciousness or in the personality, nausea, seizures, nuchal rigidity, photophobia, vomiting, lethargy and myalgia, eventual cutaneous rash, lymphadenopathy, and hepatosplenomegaly. 13 The radiological evaluation should be done preferably by MRI, which shows hypersignal in T2, especially in the temporal and frontobasal regions, and sometimes in the thalamus and in the nuclei of the base.…”

A review of the combined medical and surgical management in patients with herpes simplex encephalitis

“…In addition, there have been 4 other reports that discuss the use of decompressive craniectomy for any cause of viral encephalitis [4,[37][38][39] whose authors also demonstrated good or excellent recovery in all patients (GOS 4 or 5). Furthermore, in a recent review of 48 patients with both bacterial and viral encephalitis treated with decompressive craniectomy Perez-Bovet et al demonstrated a favorable functional recovery in 81.25% of patients [40]. More importantly, 92.3% of patients with viral encephalitis requiring a decompressive craniectomy had a good recovery with GOS of 4 or 5.…”