Continuous Intrathecal Medication Delivery With the IRRAflow Catheter: Pearls and Early Experience

Abstract

BACKGROUND AND OBJECTIVES: Intrathecal (IT) medications are routinely introduced through catheterization of the intraventricular space or subarachnoid space. There has been sporadic use of IT medications delivered directly to the ventricle either by intermittent injection through an external ventricular drain (EVD) or by an Ommaya reservoir with a ventricular catheter. IT medication delivery through EVD has many drawbacks, including the necessary opening of a sterile system, delivery of medication in a bolus form, and requirements to clamp the EVD after medication delivery. Despite these setbacks, IT medications delivered through EVD have been used across a wide range of applications, including antibiotic delivery treatment of vasospasm with nicardipine and delivery of tissue plasminogen activator. METHODS: We used a newly developed active fluid exchange device to treat various severe conditions involved in the cerebral ventricles. Here, we present our treatment protocols and advice on the techniques related to successful active fluid exchange therapy. RESULTS: Seventy patients have been treated with our system with various conditions, including subarachnoid hemorrhage, intraventricular hemorrhage, ventriculitis, and cerebral abscess. Total complication rate was 14% with only 1 catheter occlusion and low rates of hemorrhage, infection, and spinal fluid leak. CONCLUSION: Current continuous IT medication dosages and protocols are based on reports and consensus statements evaluating intermittent instillation of medication boluses. The pharmacokinetics of continuous dosing and the therapeutic and safety profiles of the medications need to be studied in a prospective manner to evaluate the true optimal dosing standards. Furthermore, the ability to deliver continuous, sterile medications directly through an IT route will open new avenues of pharmacotherapy that were previously closed. This report serves as a basic guide for the safe and effective use of the IRRAflow active fluid exchange catheter to deliver IT medications.

Stereotactic placement of dual lumen catheter system for continuous drainage, irrigation, and intraventricular antibiotic therapy for treatment of brain abscess with ventriculitis – A case report and literature review

“…The patient’s clinical journey underscores the nuanced decision-making process in neurosurgical interventions and the critical role of innovative techniques such as the dual lumen catheter system. [ 1 , 5 , 7 , 18 , 21 ]…”

“…To overcome these challenges, the dual-lumen catheter system has emerged as an innovative solution, transforming the approach to managing such neurosurgical conditions. [ 1 , 5 , 7 , 18 , 21 ] This system uniquely integrates continuous irrigation with drainage, potentially resolving issues of catheter blockage and enhancing the delivery of antibiotics directly to the infected areas.…”

“…Regarding ventricular drainage, drawing on prior literature that suggests the high efficacy and safety of this dual-lumen catheter system in ventriculitis cases, we decided to implement this novel system. [ 5 , 7 - 9 , 15 , 16 , 18 , 21 ] We planned the procedure on a virtual model and utilized direct communication between the abscess and ventricle; the catheter tip was stereotactically placed into the abscess cavity. This strategy allowed us to create a single tract without directly manipulating the ventricular ependyma, thus minimizing hemorrhagic risk; to our knowledge, this is the first documented instance of using this device through a single stereotactic tract for concurrent treatment of an abscess cavity and ventriculitis.…”

“…This scientific report delves into the exploration of the dual lumen as a potential breakthrough in the targeted treatment of brain abscess with ventriculitis, a complex and life-threatening pathology that precipitates an infectious condition within the ventricular system paired with hydrocephalus due to altered cerebrospinal fluid (CSF) circulation and intracranial hypertension. [ 3 , 5 , 10 , 18 ] Consequently, treatment must be targeted towards both controlling the infection and managing the disturbed CSF dynamics.…”

“…Recently, the use of the Dual lumen catheter for continuous ventricular drainage and irrigation has been advanced for the management of ventricular hemorrhages[ 4 , 6 , 9 , 16 ] and infections,[ 5 , 7 , 18 , 21 ] offering a cycle of irrigation that may mitigate the risks of obstruction and infection through continuous washout of clots and bacterial colonies.…”