Multimodal cerebral monitoring and decompressive surgery for the treatment of severe bacterial meningitis with increased intracranial pressure

被引:40
作者
Baussart, B.
Cheisson, G.
Compain, M.
Leblanc, P. E.
Tadie, M.
Benhamou, D.
Duranteau, J.
机构
[1] Bicetre Hosp, Dept Neurosurg, Le Kremlin Bicetre, France
[2] Bicetre Hosp, Dept Anesthesiol, Le Kremlin Bicetre, France
[3] Sud Reunion Hosp, Dept Anesthesiol, St Pierre De La Reunion, France
关键词
bacterial meningitis; intracranial pressure; cerebral monitoring; decompressive craniectomy;
D O I
10.1111/j.1399-6576.2006.01038.x
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
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.
引用
收藏
页码:762 / 765
页数:4
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