Herpes simplex encephalitis: the role of surgical decompression

The role of acyclovir for the treatment of herpes simplex encephalitis has been well documented, but the role of surgical decompression for herpes simplex encephalitis has only rarely been mentioned. The authors report two cases of herpes simplex encephalitis that involved surgical decompression.

In the first case, a therapeutic regimen of acyclovir was begun on the 11(th) day of the clinical course, and surgical decompression was performed because of impending uncal herniation on the 13(th) day. In the second case, a therapeutic regimen of acyclovir was begun on the third day of the disease's clinical course, and surgical decompression was performed because of impending uncal herniation on the 11(th) day. Both patients had good neurological outcomes and were seizure-free 12 months after their surgical procedures.

We conclude that, for patients with herpes simplex encephalitis, it is important for the clinician to detect deterioration of consciousness because of the mass effect caused by the disease-associated inflammatory process as early as is possible. Surgical decompression is indicated for impending uncal herniation or intolerable increased intracranial pressure. Such surgery can contribute to an improved outcome for patients with herpes simplex encephalitis.