Decompressive craniectomy in herpes simplex encephalitis: a case report


  • Vinit Suri Department of Neurology, Indraprastha Apollo Hospitals, New Delhi, India
  • Swapnil Jain Department of Neurology, Indraprastha Apollo Hospitals, New Delhi, India
  • Mohit Kalangi Venkata Naga Department of Neurology, Indraprastha Apollo Hospitals, New Delhi, India
  • Sudheer Tyagi Department of Neurosurgery, Indraprastha Apollo Hospitals, New Delhi, India
  • Aditendraditya Singh Bhati Department of Neurosurgery, Indraprastha Apollo Hospitals, New Delhi, India
  • Kanika Suri Department of Internal Medicine, Indraprastha Apollo Hospitals, New Delhi, India



Encephalitis, Hemicraniectomy, Herpes simplex


Herpes Simplex Encephalitis is the commonest form of sporadic encephalitis. Availability of effective antiviral therapy viz Acyclovir has significantly reduced the mortality of Herpes Simplex Encephalitis. Elevated intracranial pressure   resulting in herniation syndromes continues to be an important cause of mortality. Antiviral therapy and medical measures for managing raised intracranial pressure including osmotic diuretics, careful usage of steroids and controlled hyperventilation continue to be the cornerstones in management of these patients. Authors present a 38-year-old male patient with Cerebrospinal fluid Meningo-encephalitic panel positivity for herpes simplex virus 1 and bilateral temporal lobe lesions with secondary decline due to impending herniation syndrome despite osmotic diuretics and steroids with patient survival and complete recovery following decompressive hemicraniectomy.


Sili U, Kaya A, Mert A, HSV Encephalitis Study Group. Herpes simplex virus encephalitis: clinical manifestations, diagnosis and outcome in 106 adult patients. J Clini Virol. 2014 Jun 1;60(2):112-8.

Singhi P, Saini AG, Sahu JK, Kumar N, Vyas S, Vasishta RK, Aggarwal A. Unusual clinical presentation and role of decompressive craniectomy in herpes simplex encephalitis. J Child Neurol. 2015 Aug;30(9):1204-7.

Panourias IG, Skiadas PK, Sakas DE, Marketos SG. Hippocrates: a pioneer in the treatment of head injuries. Neurosurg. 2005 Jul 1;57(1):181-9.

Marcotte CA. De l'hemicraniectomie temporaire. Institut International de Bibliographie Scientifique; 1896.

Kocher T. Hirnerschütterung, hirndruck und chirurgische eingriffe bei hirnkrankheiten. A. Hölder. 1901.

Fatima N, Al Rumaihi G, Shuaib A, Saqqur M. The role of decompressive craniectomy in traumatic brain injury: A systematic review and meta-analysis. Asian J Neurosurg. 2019 Apr;14(2):371.

Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007 Mar 1;6(3):215-22.

Back L, Nagaraja V, Kapur A, Eslick GD. Role of decompressive hemicraniectomy in extensive middle cerebral artery strokes: a meta‐analysis of randomised trials. Int Med J. 2015 Jul;45(7):711-7.

Alotaibi NM, Elkarim GA, Samuel N, Ayling OG, Guha D, Fallah A, et al. Effects of decompressive craniectomy on functional outcomes and death in poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg. 2017 Jan 6;127(6):1315-25.

Yao Z, Ma L, You C, He M. Decompressive Craniectomy for Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-analysis. World Neurosurg. 2018 Feb;110:121-8.

Ferro JM, Crassard I, Coutinho JM, Canhão P, Barinagarrementeria F, Cucchiara B, et al. Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data. Stroke. 2011 Oct;42(10):2825-31.

Adamo MA, Deshaies EM. Emergency decompressive craniectomy for fulminating infectious encephalitis: Report of two cases. J Neurosurg. 2008 Jan 1;108(1):174-6.

Kusulja M, Santini M. Decompressive craniectomy as salvage treatment in herpes simplex encephalitis: Two case reports. Int J Infect Dis. 2018;73:49-51.

Byun YH, Ha EJ. Decompressive craniectomy for herpes simplex encephalitis complicated by frank intracerebral hemorrhage: a case report and review of the literature. BMC Neurol. 2018;18(1):176.

Tunkel AR, Glacer CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, et al. The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clini Infect Dis. 2008;47(3):303-27.




How to Cite

Suri, V., Jain, S., Naga, M. K. V., Tyagi, S., Bhati, A. S., & Suri, K. (2020). Decompressive craniectomy in herpes simplex encephalitis: a case report. International Journal of Research in Medical Sciences, 8(7), 2705–2707.



Case Reports