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A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Decompressive craniectomy guided by cerebral microdialysis and brain tissue oxygenation in a patient with meningitis
1Département d'anesthésie-réanimation, Toulon, France. bordes.julien@neuf.fr
Abstract:
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.
Insights
Decompressive craniectomy (DC) guided by multimodal neuromonitoring, including cerebral microdialysis (MD) and brain tissue oxygen (pTiO2), successfully treated refractory intracranial hypertension in severe bacterial meningitis, leading to a favorable outcome.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Bacterial meningitis is a critical condition often complicated by intracranial hypertension.
- Current management strategies for severe bacterial meningitis with refractory intracranial hypertension are limited.
- The role of decompressive craniectomy (DC) and advanced neuromonitoring in this context is not well-established.
Observation:
- A 56-year-old woman with severe bacterial meningitis and mastoiditis experienced refractory intracranial hypertension.
- Maximal medical treatment failed to control intracranial pressure (>30 mmHg).
- Cerebral ischemia was indicated by declining brain tissue oxygen pressure (pTiO2) and microdialysis (MD) findings.
Findings:
- Bilateral decompressive craniectomy (DC) was performed, guided by multimodal neuromonitoring (MD and pTiO2).
- The patient showed a favorable neurological recovery after DC.
- This represents the first reported case of DC in bacterial meningitis guided by MD and pTiO2.
Implications:
- Invasive multimodal neuromonitoring (MD and pTiO2) is valuable in managing severe bacterial meningitis.
- Decompressive craniectomy (DC) is a viable option for refractory intracranial hypertension in severe bacterial meningitis.
- This approach may improve neurological outcomes in life-threatening meningitis cases.
