A flexible metal ventricular catheter for treatment of complicated and protracted infections of the cerebrospinal fluid spaces: Preliminary experiences

Abstract

In the management of shunt infection, the use of ventricular catheters made of silicone rubber for the temporary external drainage of cerebrospinal fluid (CSF) is general practice. However, the eradication of the primary source of infection may be hindered by the affinity of bacteria to silicone-based material. Compared to silicone catheters, a metal drainage device for temporary ventriculostomy appears to offer more favourable conditions for successful eradication of the infection. Since metal needles cannot be implanted permanently and since their screw-type fixation precludes attachment to the skulls of infants or small children, we developed a flexible metal catheter. This catheter was used exclusively for the treatment of particularly serious or chronic infections of the CSF spaces. The catheter is made of implantation steel and consists of a corrugated tube that renders it flexible. Cerebrospinal fluid drains into a receptable bulb at the tip of the tube. Tubing of other materials may be connected to the end of the metal catheter for either external or internal drainage. It was implanted as a temporary and later permanent CSF drainage in 7 male patients aged from 4 to 60 years, who suffered from chronic, recurrent ventriculitis (n = 5) with an average of 7 previous surgical revisions, as well as from complex infections (n = 2; basal tuberculous meningitis, brain abscess). The infections were successfully eliminated in 6 patients. In the remaining patient, the metal catheter for external ventriculostomy had to be removed after 4 days due a leakage of CSF; it was replaced by a silicone catheter and later on by a needle drainage. Other complications, such as secondary infection or intracerebral haemorrhage, did not occur. The average duration of external CSF drainage via the flexible metal catheter was 27 days (range 4-50 days). In 4 patients, the CSF drainage was converted to a permanent ventriculoperitoneal shunt using a new flexible metal catheter. At the time of post-operative follow-up examination (average = 34 weeks), all shunts were functioning and there was no evidence of infection. In cases of especially complicated and protracted CSF infections, the flexible metal ventricular catheter is a promising device for treatment.

Hemorrhagic Complications of Ventriculostomy Placement: A Meta-Analysis

“…An additional review of the initially identified articles was performed for suitability, and resulted in exclusion of articles that included patients on anticoagulants, use of alternative techniques or techniques that do not reflect current procedures, or studies that reported hemorrhage as a result of underlying pathology rather than directly due to ventriculostomy (e.g., aneurysmal rebleed after ventriculostomy) [14][15][16].…”

Bedside external ventricular drain placement for the treatment of acute hydrocephalus

“…5,[8][9][10] Infectious agents have included a large spectrum of organisms including even Candida. 11,12,20 Several recent articles have described various techniques to decrease the rate of infectious complications, such as flexible metal ventriculostomies 13,14 or longtunnel ventriculostomies, which require a separate procedure. 15 Others have recommended placement of the EVD in the operating room (OR).…”

Metal external ventricular drainage catheters in the treatment of persistent ventriculitis - an old story made new. technical note and preliminary results

“…Catheter-associated infection of the cerebrospinal fluid (CSF) is a well-known and eventually devastating complication of external ventricular drainage (EVD) (2,13). The infection rate can be as high as 30% and increases three-fold more than 18 days after implantation of conventional (silicon) catheters (23,25). Even though it is standard practice to administer antibiotics prophylactically (15), the CSF infection cannot be totally excluded (13,25).…”

“…In order to minimize the risk of ventriculitis several approaches have been proposed both for adults (9,13,17,21) and children (20,22,24,25); percutaneous needle puncture (25), 'Duisburger Nadel' (10), endoscopic third ventriculostomy alone or combined with choroid plexus (24), antibiotic-impregnated catheters (AIC) (17,21,22), nanoparticles (silver)-impregnated catheters (9,13) and flexible metal ventricular catheters (23) represent only some of the current practices. In the case of verified ventriculitis the choice of the appropriate catheter to use is far more troublesome.…”

“…The scope of this report is to highlight the enhanced therapeutic potential of metal catheters as compared to the conventional (silicon) ones in selected cases of protracted ventriculitis in patients with extended length of stay in an intensive care unit (ICU). To the authors' knowledge there are only 2 articles in the English literature commenting on the superiority of a metal catheter in treating complicated infection of the ventricles (23,25). The efficacy of colistin in eradicating multidrug-resistant bacteria such as Acinetobacter baumannii is additionally underlined (7,12).…”