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October 1, 1982

Diagnosis of Herpes Simplex Virus Encephalitis

JAMA. 1982;248(13):1579. doi:10.1001/jama.1982.03330130027013

To the Editor.—  In an editorial, "Herpes Simplex Virus Encephalitis" (1982;247:337) by Sam U. Ho, MD, and Donald H. Harter, MD, the statement was made that, "In fact, the risk of subjecting a sick patient to general anesthesia and craniotomy for brain biopsy is far greater than the five extra days of fluid overload."In actual fact, as an operating neurosurgeon with considerable experience taking brain biopsies in very sick patients suffering from a number of different diseases,1-4 I can testify to the erroneous emphasis in that statement. In particular, I refer to the words, "far greater," and also to the assumption that "general anesthesia" is necessary. Biopsies are easily done through a small burr hole with virtually no risk whatever, even if more than one location must be used. Removal of small amounts of tissue can be done without difficulty and without risk, even when subsurface material is required.