title: Decompressive craniectomy for encephalitis with brain herniation: case report and review of the literature.
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.
authors.affiliation: Neurosurgery Department, Universitary Hospital Dr. Josep Trueta, Carretera de França S/N, 17007, Girona, Girona, Spain. sgf_39@hotmail.com
authors.forename: Jordi
authors.initials: J
authors.lastname: Pérez-Bovet
authors.forename: Roser
authors.initials: R
authors.lastname: Garcia-Armengol
authors.forename: Maria
authors.initials: M
authors.lastname: Buxó-Pujolràs
authors.forename: Nadia
authors.initials: N
authors.lastname: Lorite-Díaz
authors.forename: Yislenz
authors.initials: Y
authors.lastname: Narváez-Martínez
authors.forename: José Luis
authors.initials: JL
authors.lastname: Caro-Cardera
authors.forename: Jordi
authors.initials: J
authors.lastname: Rimbau-Muñoz
authors.forename: M Carme
authors.initials: MC
authors.lastname: Joly-Torta
authors.forename: Marina
authors.initials: M
authors.lastname: Castellví-Joan
authors.forename: Secundino
authors.initials: S
authors.lastname: Martín-Ferrer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D001921:Brain / Q000473:pathology; D001929:Brain Edema / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D056424:Decompressive Craniectomy / Q000379:methods*; D004660:Encephalitis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D018792:Encephalitis, Viral / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D004677:Encephalocele / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007223:Infant; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D008279:Magnetic Resonance Imaging; D016982:Micrococcus luteus; D008875:Middle Aged; D009460:Neurologic Examination; D014057:Tomography, X-Ray Computed; D055815:Young Adult