title: Herpes simplex encephalitis as a complication of neurosurgical procedures: report of 3 cases and review of the literature.
abstract: BACKGROUND
  Herpes simplex virus (HSV) is the most common identified cause of focal encephalitis worldwide. However, postoperative HSV encephalitis (HSVE) is a rare complication of neurosurgical procedures and a significant clinical challenge
  
  
  METHODS
  We describe 3 cases of postoperative HSVE and review all published reports. A total of 23 cases were identified.
  
  
  CONCLUSIONS
  Clinical heterogeneity represents a diagnostic challenge in the postoperative setting. Cerebral magnetic resonance imaging showed typical findings in a minority of patients only, whereas HSV-specific polymerase chain reaction on the cerebrospinal fluid proved to be a valuable test. The postoperative viral pathophysiology remains a subject of debate. The rate of adverse outcome is high and early antiviral treatment seems to be a strong predictor of clinical outcome.
  
  
  CONCLUSIONS
  We recommend early empirical treatment for any patient presenting with post-neurosurgical lymphocytic meningo-encephalitis, and prophylactic antiviral treatment for patients with a history of previous HSVE who will undergo a neurosurgical procedure.
authors.affiliation: Division of General Internal Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland. David.Jaques@hcuge.ch.
authors.forename: David A
authors.initials: DA
authors.lastname: Jaques
authors.affiliation: Division of General Pediatrics, Child and Adolescent Department, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Spyridoula
authors.initials: S
authors.lastname: Bagetakou
authors.affiliation: Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
authors.forename: Arnaud G
authors.initials: AG
authors.lastname: L'Huillier
authors.affiliation: Neurosurgery Division, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bartoli
authors.affiliation: Neuroradiology Department, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Maria-Isabel
authors.initials: MI
authors.lastname: Vargas
authors.affiliation: Pediatric Neurology Unit, Pediatric Subspecialties Service, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Joel
authors.initials: J
authors.lastname: Fluss
authors.affiliation: Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland. Laurent.Kaiser@hcuge.ch.|University of Geneva Medical School, Geneva, Switzerland. Laurent.Kaiser@hcuge.ch.
authors.forename: Laurent
authors.initials: L
authors.lastname: Kaiser
mesh_terms: D002555:Cerebrospinal Fluid / Q000821:virology; D002648:Child; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000175:diagnosis* / Q000473:pathology*; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complication; Encephalitis; Herpes simplex virus; Meningitis; Neurosurgery; Postoperative