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Journal of Neurosurgical Sciences 2021 Aug 03

DOI: 10.23736/S0390-5616.21.05397-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Meningoencephalitis with refractory intracranial hypertension : Consider Decompressive craniectomy

Anis CHOUCHA 1 , Sebastien BOISSONNEAU 1, 2, Nathan BEUCLER 3, Thomas GRAILLON 1, 4, Stephane RANQUE 5, 6, Nicolas BRUDER 1, 7, Stephane FUENTES 1, 8, Lionel VELLY 7, 9, Henry DUFOUR 1, 4

1 Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France; 2 Inst Neurosci Syst, Aix Marseille Univ, INSERM, INS, Marseille, France; 3 Department of Neurosurgery, Sainte-Anne Military Teaching Hospital, Toulon, France; 4 Inst Neurosci Timone, Aix Marseille Univ, CNRS, CRN2M, Marseille, France; 5 Aix Marseille Univ, IRD, APHM, SSA, VITROME, Marseille, France; 6 IHU Méditerranée Infection, Marseille, France; 7 Inst Neurosci Timone, Aix Marseille Univ, CNRS, INT, Marseille, France; 8 Spine Unit, Department of Neurosurgery, Aix Marseille Univ, APHM, UH Timone, Marseille, France; 9 Department of Anaesthesiology and Critical Care Medicine, Aix Marseille Univ, APHM, UH Timone, Marseille, France


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BACKGROUND: The benefits of decompressive craniectomy (DC) have been demonstrated in malignant ischemic stroke and traumatic brain injuries with refractory intracranial hypertension (ICH) by randomized controlled trials. Some reports advocate the potential of DC in the context of ICH due to meningoencephalitis (ME) with focal cerebral edema but its interest remains controversial especially when there is diffuse cerebral edema. The aim of this study is to assess the benefits of DC in meningoencephalitis with malignant cerebral edema whether it is focal or diffuse.
METHODS: We report two cases successfully treated in our instution, plus we conducted a systematic literature review focused on cases of DC in ME in compliance with prisma guidelines.
RESULTS: the first patient is a 36-years-old woman who suffered from fulminant pneumococcal meningoencephalitis (ME) with refractory ICH following a transphenoidal removal of pituitary adenoma. The second patient is a 20-years-old man suffering from neuromeningeal cryptococcosis with refractory ICH. In both cases DC led to major clinical improvement with a GOS-E 8 at one year. These results are consistent with the literature review which reports a favorable outcome in 85% of cases.
CONCLUSIONS: DC appears to be a promising therapeutic option in cases of ME with refractory ICH. Thus, reliable criteria will have to be defined to guide us in our practice in emergency cases where DC has not been part of the therapeutic arsenal yet.


KEY WORDS: Cryptococcus; Encephalitis; Meningo-encephalitis; Meningitis; Craniectomy; Decompressive; Intracranial; Hypertension; Declarations

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