[Severe herpes simplex encephalitis: course 15 years following decompressive craniotomy]

Decompressive craniotomy with brain biopsy was carried out in two patients with herpes simplex virus encephalitis (HSE). In both cases the indication for surgery was based on the clinical picture of coma with rapidly progressive hemiparesis and on the computer tomographic finding of a large space-occupying lesion of in the temporal lobe accompanied by brain stem compression not controllable by medication. Both patients were treated with a standard dosage of vidarabine (Ara-A 15 mg/kg/24 h) and corticosteroids after the operation. The improvement attained by surgery was very impressive in both cases. The massive neurological deficits (which also included subtotal aphasia in one case) regressed to a minimum in the following weeks. Both patients were followed up at yearly intervals for 15 years. They are now 36 and 76 years of age, both in a very satisfactory condition. Our observations show that decompressive craniotomy with duraplasty may be the crucial therapeutic measure in HSE with brainstem compression not controllable by medication.