Surgical Management in Herpes Simplex Encephalitis: Illustrative Case Report and Systematic Review of the Literature.
Neurosurgery
; 92(5): 915-933, 2023 05 01.
Article
em En
| MEDLINE
| ID: mdl-36700784
ABSTRACT
BACKGROUND:
Herpes simplex virus (HSV) is a common cause of viral encephalitis and can result in refractory seizures. Although HSV encephalitis (HSVE) is treated primarily with acyclovir, surgery can play a role in medically intractable cases.OBJECTIVE:
To systematically review cases describing surgery for the treatment of severe HSVE. We also present an illustrative case of anterior temporal lobectomy (ATL) for refractory status epilepticus in a patient with unilateral HSVE. This case demonstrates one clinical context in which surgery can be a useful adjunct.METHODS:
We performed a systematic review using PubMed and Google Scholar, including case reports and series describing surgical interventions for HSVE. Clinical data were extracted from 54 publications that incorporated 67 patient cases.RESULTS:
Surgical decompression occurred at a wide range of times after the onset of illness, although most patients were operated on 4 or more days after HSVE symptoms began. Numerous reports indicated that decompressive craniectomy, temporal lobectomy, and hematoma removal could treat intractably elevated intracranial pressure because of HSVE with favorable long-term outcomes. We describe an additional case in which a 52-year-old woman with HSVE developed refractory right temporal lobe seizures. After ATL, the seizures resolved with significant clinical improvement.CONCLUSION:
Surgical treatment can be a useful adjunct for treatment of HSVE. There is substantial variability in the timing of surgical decompression in patients with HSVE, which can be necessary up to approximately 3 weeks after illness onset. ATL should be considered for refractory status epilepticus in HSVE with a unilateral seizure focus.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Estado Epiléptico
/
Encefalite por Herpes Simples
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article