Decompressive Craniectomy and Partial Temporal Lobectomy for Herpes Simplex Virus Encephalitis with Refractory Intracranial Hypertension in an Adolescent

Abstract

Herpes simplex virus (HSV) encephalitis is an uncommon, but potentially devastating brain infection with significant morbidity and mortality. Some patients develop a brainstem herniation syndrome because the virus has a predilection for the temporal lobes despite prompt treatment with the antiviral drug aciclovir. We report a case of HSV encephalitis in an adolescent who developed severe cerebral oedema and subfalcine herniation which was refractory to medical management. He underwent a decompressive craniectomy with partial right temporal lobectomy. He made a rapid recovery with no physical deficits though he has some residual neuropsychological problems similar to those reported following HSV encephalitis previously. Neurosurgical intervention appears to be uncommon in HSV encephalitis: to our knowledge only four other children are reported to have had a similar procedure. We describe our case in detail and provide a full review of the literature surrounding neurosurgical intervention in severe HSV encephalitis.