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

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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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Acknowledgements

We acknowledge the help provided by:

Simone Nobel for the translation of non-English literature.

Esther Sarrià Vega for the literature research.

Conflicts of interest

None.

Disclosure

The authors report no conflict of interest concerning the materials or methods used, or the findings specified in this study.

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Authors and Affiliations

  1. Neurosurgery Department, Universitary Hospital Dr. Josep Trueta, Carretera de França S/N, 17007, Girona, Girona, Spain

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

  2. Bioestadística UCICEC (Unidad Central de Investigación Clínica y Ensayos Clínicos), Girona, Spain

    Maria Buxó-Pujolràs

  3. CAIBER (Consorcio de Apoyo a la Investigación Biomédica en Red), Girona, Spain

    Maria Buxó-Pujolràs

  4. IdIBGi (Institut d’Investigació Biomèdica de Girona), Girona, Spain

    Maria Buxó-Pujolràs

  5. Department of Health, Epidemiology Unit and Cancer Registry of Girona, Oncology Planning, Girona Biomedical Research Institute, Girona, Spain

    Maria Buxó-Pujolràs

  6. Health Inequalities Research Group-Employment Conditions Knowledge Network (GREDS-EMCONET), Barcelona, Spain

    Maria Buxó-Pujolràs

  7. Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain

    Maria Buxó-Pujolràs

Authors
  1. Jordi Pérez-Bovet
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  2. Roser Garcia-Armengol
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  3. Maria Buxó-Pujolràs
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  4. Nadia Lorite-Díaz
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  5. Yislenz Narváez-Martínez
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  6. José Luis Caro-Cardera
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  7. Jordi Rimbau-Muñoz
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  8. Mª Carme Joly-Torta
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  9. Marina Castellví-Joan
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  10. Secundino Martín-Ferrer
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Corresponding author

Correspondence to Jordi Pérez-Bovet.

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Pérez-Bovet, J., Garcia-Armengol, R., Buxó-Pujolràs, M. et al. Decompressive craniectomy for encephalitis with brain herniation: case report and review of the literature. Acta Neurochir 154, 1717–1724 (2012). https://doi.org/10.1007/s00701-012-1323-3

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  • DOI: https://doi.org/10.1007/s00701-012-1323-3

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