title: Decompressive craniectomy and early cranioplasty in a 15-year-old boy with N. meningitidis meningitis.
abstract: BACKGROUND
  Intracranial hypertension is a well-known life-threatening complication of bacterial meningitis. Investigations on decompressive craniectomy after failure of conservative management are scarce, but this surgical treatment should be considered and performed expeditiously, as it lowers the intracranial pressure and improves brain tissue oxygenation. Early cranioplasty can further aid the rehabilitation.
  
  
  METHODS
  A 15-year-old boy was admitted to our emergency department because of sudden onset of neurologic decline and consecutive loss of consciousness. Clinical examination and imaging showed elevated intracranial pressure, leading to the suspected diagnosis of meningitis. Intracranial pressure monitoring was installed, but the initiated conservative management failed. Finally, the patient underwent bilateral decompressive craniectomy. The microbiological test showed growth of Neisseria meningitidis. After full neurologic recovery, cranioplasty with two CAD/CAM titanium implants was conducted successfully.
  
  
  CONCLUSIONS
  This unique report shows that decompressive craniotomy with duroplasty may be a crucial therapeutic approach in bacterial meningitis with refractory increased intracranial pressure and brainstem compression. Early cranioplasty with a patient-specific implant allowed the early and full reintegration of the patient.
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
authors.forename: Julius
authors.initials: J
authors.lastname: Hoehne
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Friedrich
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Brawanski
authors.affiliation: Department of Pediatrics, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Melter
authors.affiliation: Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
authors.forename: Karl-Michael
authors.initials: KM
authors.lastname: Schebesch
keywords: Cranioplasty; Neisseria meningitidis; W/Y-135; computer-aided design/computer-aided manufacturing; encephalitis; intracranial pressure; meningitis; meningococcal disease