Interdisciplinary Neurosurgery (Jun 2021)
Decompressive craniectomy for treatment of elevated intracranial pressure in community-acquired bacterial meningitis: Case study, literature review, and proposed guidelines
Abstract
Introduction: Despite optimal medical treatments for community-acquired bacterial meningitis (CABM), fatality rates are still significant, in part due to exaggerated inflammatory responses resulting in elevated intracranial pressure (ICP). Decompressive craniectomy (DC) has not been commonly used for elevated ICP in CABM. This report aims to describe the use of DC as a last-tier therapy in CABM by examining our case study along with the existing literature and consequentially to establish institutional guidelines for appropriate use. Case Report: A 22 year old male presented to the Shaare Zedek Medical Center with progressive confusion, a fall, and a fever that began 1.5 days prior. After admission, the patient had a seizure and declined neurologically. A CT showed mild traumatic subarachnoid hemorrhage, and an LP was performed confirming the diagnosis of Pneumoncoccal meningitis. Medical treatment was initiated including antibiotics.After continued neurologic deterioration, the patient was intubated and an ICP monitor was placed. At 36 h post admission, medical management for elevated ICP failed and a right fronto-parietal-temporal-occipital DC was successfully performed. ICP returned to acceptable levels and within the second postoperative week the patient was communicating. He made a full recovery. Conclusion: This case demonstrates a favorable outcome after DC for CABM with fulminant ICP. Based on this case and those reported in our literature search, we propose that DC be considered as a treatment in select CABM patients.
