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

• 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
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2010.02355.x

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.