Meningoencephalitis with refractory intracranial hypertension: consider decompressive craniectomy.

Autor:	Choucha A; Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, Marseille, France - anis.c13@gmail.com., Boissonneau S; Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, Marseille, France.; Systems Neuroscience Institute, Aix Marseille University, INSERM, INS, Marseille, France., Beucler N; Department of Neurosurgery, Sainte-Anne Military Teaching Hospital, Toulon, France., Graillon T; Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, Marseille, France.; Institute Neuroscience Timone, Aix Marseille Univ, CNRS, CRN2M, Marseille, France., Ranque S; Aix Marseille University, IRD, APHM, SSA, VITROME, Marseille, France.; IHU Méditerranée Infection, Marseille, France., Bruder N; Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, Marseille, France.; Institute Neuroscience Timone, Aix Marseille Univ, CNRS, CRN2M, Marseille, France., Fuentes S; Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, Marseille, France.; Department of Neurosurgery, Spine Unit, Aix Marseille University, APHM, UH Timone, Marseille, France., Velly L; Institute Neuroscience Timone, Aix Marseille Univ, CNRS, CRN2M, Marseille, France.; Department of Anesthesiology and Critical Care Medicine, Aix Marseille Univ, AP-HM, UH Timone, Marseille, France., Dufour H; Department of Neurosurgery, Aix Marseille University, APHM, UH Timone, Marseille, France.; Institute Neuroscience Timone, Aix Marseille Univ, CNRS, CRN2M, Marseille, France.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgical sciences [J Neurosurg Sci] 2023 Apr; Vol. 67 (2), pp. 248-256. Date of Electronic Publication: 2021 Aug 03.
DOI:	10.23736/S0390-5616.21.05397-2
Abstrakt:	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. We report two cases successfully treated in our institute, plus we conducted a systematic literature review focused on cases of DC in ME in compliance with Prisma guidelines. The first patient is a 36-year-old woman who suffered from fulminant pneumococcal meningoencephalitis (ME) with refractory ICH following a transsphenoidal removal of pituitary adenoma. The second patient is a 20-year-old man suffering from neuro-meningeal 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. 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.
Databáze:	MEDLINE
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