Decompressive Craniectomy With Abdominal Bone Flap Preservation in Herpes Simplex Encephalitis: A Case Report

Herpes simplex encephalitis (HSE) is a rare but severe condition that can lead to significant morbidity and mortality. Although antiviral therapy with acyclovir has improved outcomes, some patients develop complications such as focal hemorrhagic necrosis and edema in the temporal lobe, with subsequent elevation of intracranial pressure (ICP) and uncal herniation, necessitating surgical intervention. We report a pediatric case of HSE with life-threatening ICP refractory to sedation, osmotic therapy, and moderate hyperventilation. Despite aggressive treatment, the patient underwent a left-sided decompressive hemicraniectomy, with the bone flap preserved in a subcutaneous abdominal pocket, a technique shown in previous studies to maintain bone viability and minimize infection risk. This approach effectively controlled ICP and allowed progressive neurological recovery. At three-month follow-ups, the patient demonstrated favorable neurological outcomes (Glasgow Outcome Scale = 5) with successful autologous cranial reconstruction.