Operative treatment of tentorial herniation in herpes encephalitis

Herpes simplex Virus is the most common cause of acute viral encephalitis i n children. Due to the variety of possible-clinical manifestations the diag nosis is often overlooked in the early stages of the disease. Anti-viral th erapy with acyclovir should be started whenever HSE is suspected. When ther e is further deterioration under virostatic therapy, a brain biopsy should be performed to verify the diagnosis. But even when the adequate medical th erapy is established, massive brain edema and brain shift resulting in tent orial herniation can develop. Up to now the reported mortality of these pat ients is stilI around 30%. Here we report on a child with severe necrotizin g herpes simplex encephalitis who developed severe tentorial herniation due to a right-sided mass lesion. The patient's status markedly improved after decompressive anterior temporal lobe resection. To our knowledge a similar case has not yet been reported in the literature. We suggest that anterior temporal lobe resection and decompressive craniotomy is of benefit in sele cted cases with tentorial herniation because both decompression and reducti on of infectious material can be achieved.