Decompressive craniectomy for medically refractory intracranial hypertension due to meningoencephalitis: report of three patients.

BACKGROUND: Meningoencephalitis may sometimes cause medically refractory intracranial hypertension and brain herniation. In such patients death is common. There are a limited number of reports on the use of decompressive craniectomy as a life saving measure in these circumstances with some good results. The aim of the study was to report experience in three further patients.
MATERIALS AND METHODS: In a 15-month period, three patients affected by acute meningoencephalitis were surgically treated by decompressive craniectomy at the Department of Neurosurgery of the Polytechnic University of Ancona. In all patients common symptoms at presentation were headache, fever and neck rigidity, rapidly followed by the development of focal neurological deficits and coma. Intracranial pressure monitoring was always performed and correlated with serial CT scan examinations. Because of the development of severe intracranial hypertension refractory to conventional medical treatment, a decompressive hemicraniectomy was performed in two patients and a bifrontal decompressive craniectomy in the third one. Bacterial meningoencephalitis was diagnosed in two patients, viral meningoencephalitis in the remaining one.
FINDINGS: One patient died 3 days after surgery. The remaining two completely recovered consciousness, with no residual focal neurological deficit.
CONCLUSIONS: Surgery resulted in an immediate reduction of intracranial pressure in two of the three patients with severe meningoencephalitis. Decompressive craniectomy may be a useful option in the management of a patient with medically refractory intracranial hypertension caused by meningoencephalitis. Early intervention may enhance its benefits.