Premium
Decompressive craniectomy guided by cerebral microdialysis and brain tissue oxygenation in a patient with meningitis
Author(s) -
BORDES J.,
BORET H.,
LACROIX G.,
PRUNET B.,
MEAUDRE E.,
KAISER E.
Publication year - 2011
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2010.02355.x
Subject(s) - medicine , decompressive craniectomy , intracranial pressure , meningitis , anesthesia , microdialysis , bacterial meningitis , brain tissue , surgery , traumatic brain injury , central nervous system , psychiatry
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 (pTiO 2 ) 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 pTiO 2 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 pTiO 2 . Invasive multimodal neuromonitoring should be used in severe meningitis and DC could be considered in the case of refractory intracranial hypertension.