Stula D, Lyrer P
Neurochirurgische Universitätsklinik, Kantonsspital Basel.
Schweiz Med Wochenschr. 1992 Jul 25;122(30):1137-40.
Decompressive craniotomy with brain biopsy was carried out in two patients with herpes simplex virus encephalitis (HSE). In both cases the indication for surgery was based on the clinical picture of coma with rapidly progressive hemiparesis and on the computer tomographic finding of a large space-occupying lesion of in the temporal lobe accompanied by brain stem compression not controllable by medication. Both patients were treated with a standard dosage of vidarabine (Ara-A 15 mg/kg/24 h) and corticosteroids after the operation. The improvement attained by surgery was very impressive in both cases. The massive neurological deficits (which also included subtotal aphasia in one case) regressed to a minimum in the following weeks. Both patients were followed up at yearly intervals for 15 years. They are now 36 and 76 years of age, both in a very satisfactory condition. Our observations show that decompressive craniotomy with duraplasty may be the crucial therapeutic measure in HSE with brainstem compression not controllable by medication.
对两名单纯疱疹病毒性脑炎（HSE）患者进行了减压性开颅手术并取脑活检。在这两例病例中，手术指征均基于昏迷伴快速进展性偏瘫的临床表现以及计算机断层扫描显示颞叶有巨大占位性病变并伴有药物无法控制的脑干受压。两名患者术后均接受了标准剂量的阿糖腺苷（Ara - A 15 mg/kg/24 h）和皮质类固醇治疗。两例病例中手术带来的改善都非常显著。严重的神经功能缺损（其中一例还包括不完全性失语）在接下来的几周内减轻到最低程度。两名患者每年接受一次随访，为期15年。他们现在分别为36岁和76岁，身体状况都非常令人满意。我们的观察表明，对于药物无法控制脑干受压的HSE患者，减压性开颅并硬脑膜成形术可能是关键的治疗措施。
