Decompressive craniectomy guided by cerebral microdialysis and brain tissue oxygenation in a patient with meningitis

Bacterial meningitis remains a life‐threatening disease mainly due to intracranial hypertension. However, decompressive craniectomy (DC) and the use of cerebral microdialysis (MD) and brain tissue oxygen pressure measurement (pTiO2) are poorly described in this disease. We report a case of a 56‐year...

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Bibliographic Details
Published in:Acta anaesthesiologica Scandinavica 2011-01, Vol.55 (1), p.130-133
Main Authors: BORDES, J., BORET, H., LACROIX, G., PRUNET, B., MEAUDRE, E., KAISER, E.
Format: Article
Language:English
Subjects:
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Brain - diagnostic imaging
Brain Chemistry - physiology
Brain Ischemia - surgery
Craniotomy
Decompression, Surgical
Female
Glasgow Coma Scale
Humans
Mastoiditis - complications
Medical sciences
Meningitis, Bacterial - diagnostic imaging
Meningitis, Bacterial - metabolism
Meningitis, Bacterial - surgery
Microdialysis - methods
Middle Aged
Monitoring, Physiologic - methods
Oxygen - blood
Tomography, X-Ray Computed
Treatment Outcome
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Summary:Bacterial meningitis remains a life‐threatening disease mainly due to intracranial hypertension. However, decompressive craniectomy (DC) and the use of cerebral microdialysis (MD) and brain tissue oxygen pressure measurement (pTiO2) are poorly described in this disease. We report a case of a 56‐year‐old woman admitted for severe bacterial meningitis complicating mastoiditis. Despite maximal medical treatment, intracranial pressure increased above 30 mmHg, with a decline in pTiO2 and MD results indicating cerebral ischaemia. A bilateral DC was performed. Neurological outcome was favourable, and on discharge, the patient was able to live independently. This is the first report of DC in meningitis guided by cerebral MD and pTiO2. Invasive multimodal neuromonitoring should be used in severe meningitis and DC could be considered in the case of refractory intracranial hypertension.
ISSN:0001-5172
1399-6576
DOI:10.1111/j.1399-6576.2010.02355.x