CRANIECTOMY - AN AGGRESSIVE TREATMENT APPROACH IN SEVERE ENCEPHALITIS

Background and objective: Focal encephalitis may be associated with br ain edema, which is often fatal. The control of intracranial pressure (ICP) is therefore crucial for further therapeutic strategies in space -occupying edema following encephalitis. However, aggressive treatment strategies such as hemicraniectomy have not been described in a large r series of patients. Patients and methods: We describe the clinical c ourse and outcome in six patients who developed severe brain edema ass ociated with acute encephalitis. All received maximum medical treatmen t for elevated ICP, but with signs of brainstem compression emerging, hemicraniectomy was pet-formed to control ICP. Results: All patients h ad a very severe encephalitic syndrome and were treated over the cours e of weeks in the neurocritical care unit (NCCU). However, all patient s recovered almost completely and showed only mild or no neurologic de ficit when reexamined after 4 months to 3 years. Conclusion: Hemicrani ectomy should be considered in patients with severe brain edema follow ing encephalitis as a potentially lifesaving therapeutic measure. More over, the initial neurologic deficit seems to have no impact on the lo ng-term clinical outcome.