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01.09.2012 | Review Article

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

verfasst von: Jordi Pérez-Bovet, Roser Garcia-Armengol, Maria Buxó-Pujolràs, Nadia Lorite-Díaz, Yislenz Narváez-Martínez, José Luis Caro-Cardera, Jordi Rimbau-Muñoz, Mª Carme Joly-Torta, Marina Castellví-Joan, Secundino Martín-Ferrer

Erschienen in: Acta Neurochirurgica | Ausgabe 9/2012

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Abstract

Background

Decompressive craniectomy (DC) has been sporadically used in cases of infectious encephalitis with brain herniation. Like for other indications of DC, evidence is lacking regarding the beneficial or detrimental effects for this pathology.

Methods

We reviewed all the cases of viral and bacterial encephalitis treated with decompressive craniectomy reported in the literature. We also present one case from our institution. These data were analyzed to determine the relation between clinical and epidemiological variables and outcome in surgically treated patients.

Results

Of 48 patients, 39 (81.25 %) had a favorable functional recovery and 9 (18.75 %) had a negative course. Only two patients (4 %) died after surgical treatment. A statistically significant association was found between diagnosis (viral and bacterial encephalitis) and outcome (GOS) in surgically treated patients. Viral encephalitis, usually caused by herpes simplex virus (HSV), has a more favorable outcome (92.3 % with GOS 4 or 5) than bacterial encephalitis (56.2 % with GOS 4 or 5).

Conclusions

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.

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Titel: Decompressive craniectomy for encephalitis with brain herniation: case report and review of the literature
verfasst von: Jordi Pérez-Bovet
Roser Garcia-Armengol
Maria Buxó-Pujolràs
Nadia Lorite-Díaz
Yislenz Narváez-Martínez
José Luis Caro-Cardera
Jordi Rimbau-Muñoz
Mª Carme Joly-Torta
Marina Castellví-Joan
Secundino Martín-Ferrer
Publikationsdatum: 01.09.2012
Verlag: Springer Vienna
Erschienen in: Acta Neurochirurgica / Ausgabe 9/2012
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-012-1323-3

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Background

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