Baussart B, Cheisson G, Compain M, Leblanc P E, Tadie M, Benhamou D, Duranteau J
Department of Neurosurgery, Bicetre Hospital, Le Kremlin-Bicetre, France.
Acta Anaesthesiol Scand. 2006 Jul;50(6):762-5. doi: 10.1111/j.1399-6576.2006.01038.x.
Bacterial meningitis is still associated with a high mortality, mainly because of cerebral herniation as a result of increased intracranial pressure. Published data stress the necessity of an early diagnosis and immediate start of antibiotic therapy. Nevertheless, there are only few reports in which therapeutic strategy was based on the monitoring and the reduction of intracranial pressure (ICP). We report one case of bacterial meningitis caused by Neisseria meningitidis with an initial ICP value of 60 mmHg, which was treated by large hemicraniectomy and ventriculostomy, leading to a favorable neurological long-term result. The surgical decision was accelerated by an accurate ICP evaluation based on cerebral monitoring [transcranial Doppler ultrasonography (TCD) and intracranial ICP-device]. In selected patients with bacterial meningitis and clinical and radiological evidence of elevated ICP, cerebral monitoring and aggressive reduction of ICP may be crucial to improve survival and neurological outcome. When maximal medical ICP treatment fails to reduce severe intracranial hypertension, decompressive craniectomy should be rapidly proposed.
细菌性脑膜炎的死亡率仍然很高，主要原因是颅内压升高导致脑疝。已发表的数据强调了早期诊断和立即开始抗生素治疗的必要性。然而，仅有少数报告中治疗策略是基于颅内压（ICP）的监测及降低。我们报告1例由脑膜炎奈瑟菌引起的细菌性脑膜炎病例，初始ICP值为60 mmHg，通过大骨瓣开颅术和脑室造瘘术进行治疗，获得了良好的长期神经学结果。基于脑监测[经颅多普勒超声（TCD）和颅内ICP装置]进行的准确ICP评估加速了手术决策。在选定的患有细菌性脑膜炎且有临床和影像学证据显示ICP升高的患者中，脑监测和积极降低ICP对于提高生存率和神经学转归可能至关重要。当最大程度的药物性ICP治疗未能降低严重的颅内高压时，应迅速建议进行减压性颅骨切除术。
