[Decompressive craniotomy in herpes simplex encephalitis].

Two patients with herpes simplex encephalitis (HSE) underwent decompressive craniotomy with brain biopsy. The indication for the procedure was in both cases computertomographic finding of a large, space-occupying process situated in the temple lobe with clinical picture involving febrile state, progressive hemiparesis, and subconsciousness. The patients were treated with standard doses of Ara A and methylprednisolone immediately after operation. In both cases, the improvement was very impressive. The massive neurological deficits -- in one case even including subtotal aphasia -- disappeared almost completely in the weeks following operation. 6 months later both patients underwent cranioplasty. These observations show that decompressive craniotomy with dilatation of the dura represents a decisive therapeutic approach in the case of HSE when the pressure of the brain cannot be brought under control by medical treatment. Computertomography proved to be of particular diagnostic value and assists in taking decisions for meaningful surgical treatment.