Effectiveness of neuroendoscopic ventricular irrigation for ventriculitis

Terada, Yukinori; Mineharu, Yohei; Arakawa, Yoshiki; Funaki, Takeshi; Tanji, Masahiro; Miyamoto, Susumu

doi:10.1016/j.clineuro.2016.05.010

Cited by 22 publications

(25 citation statements)

References 9 publications

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“…Terada et al . [8] compared treatment of ventriculitis with neuroendoscopic ventricular irrigation (6 cases) and conventional treatment (8 cases). Result of the report showed shorter duration of EVD placement and better clinical outcome (mRS≤3).…”

Section: Discussionmentioning

confidence: 99%

Neuroendoscopic aspiration and lavage of intraventricular empyema following shunt infection in infants

Tandean¹,

Hendriansyah²,

Djokomuljanto³

et al. 2018

Pan Afr Med J

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Bacterial ventriculitis is one of the most common and serious complications of shunt placement. Shunt infection has varied management and is difficult to treat neurosurgically. We report a case of intraventricular empyema due to shunt infection. Standard management was failed for this case and reaccumulation of pus in the both ventricles. Neuroendoscopic surgery with intraventricular lavage and aspiration using cannula nasogastric tube (NGT) through a single burr hole, has successfully decreased the accumulation of intraventricular empyema. After lavage and aspiration, antibiotic can be distributed effectively to the affected area. Follow up imaging and cerebrospinal fluid (CSF) culture shown a good result and shorter length of stay in the hospital. Neuroendoscopy appears effective and safe for the management of bacterial ventriculitis due to shunt infection in infant. The strategy described in this report might be useful to treat intraventricular empyema.

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Section: Discussionmentioning

confidence: 99%

Neuroendoscopic aspiration and lavage of intraventricular empyema following shunt infection in infants

Tandean¹,

Hendriansyah²,

Djokomuljanto³

et al. 2018

Pan Afr Med J

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“…To determine the sample size, we used ClinCalc online software with the following parameters: choosing two independent groups (control group and lavage group); dichotomous; power of 80%; alpha level of 0.05; enrollment ratio of 1; and using the incidence of the primary outcome (mortality) in a similar study from Terada et al, who reported a mortality rate of 37.5% in the control group and 0% in the irrigation/lavage group. 12 The result was a minimum of 32 subjects with at least 16 subjects in each group.…”

Section: Patient Selectionmentioning

confidence: 99%

“…1,5,6 Few studies have been published on evaluating the effectiveness of ventricular irrigation or lavage in treating cerebral ventriculitis. 3,[7][8][9][10][11][12] Most of these studies are case reports or case series. Some retrospective comparative studies are also available comparing irrigation/lavage to normal conventional methods of treatment using ventricular catheters and intraventricular and systemic antibiot-ABBREVIATIONS EVD = external ventricular drain; mRS = modified Rankin Scale; VP = ventriculoperitoneal.…”

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confidence: 99%

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Outcome improvement in cerebral ventriculitis after ventricular irrigation: a prospective controlled study

Menabbawy

Refaee

Soliman

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVECerebral ventriculitis remains one of the most challenging neurosurgical conditions, with poor outcome and a long course of treatment and duration of hospital stay. Despite the current conventional management plans, i.e., using antibiotics in addition to CSF drainage, the outcome remains unsatisfactory in some cases, with no definitive therapeutic guidelines. This study aims to compare the outcome of ventricular irrigation/lavage (endoscopic irrigation or the double-drain technique) to conventional currently accepted therapy using just drainage and antibiotics.METHODSThe authors conducted a prospective controlled study in 33 patients with cerebral ventriculitis in which most of the cases were complications of CSF shunt operations. Patients were divided into two groups. Removal of the ventricular catheter whenever present was performed in both groups. The first group was managed by ventricular lavage/irrigation, while the other group was managed using conventional therapy by inserting an external ventricular drain. Both systemic and intraventricular antibiotics were used in both groups. The outcomes were compared regarding mortality rate, modified Rankin Scale (mRS) score, and duration of hospital stay.RESULTSThe mean age of the study population was 5.98 ± 7.02 years. The mean follow-up duration was 7.6 ± 3.2 months in the conventional group and 5.7 ± 3.4 months in the lavage group. The mortality rate was 25% (4/16) in the lavage group and 52.9% (9/17) in the nonlavage group (p = 0.1). The mRS score was less than 3 (good outcome) in 68.8% (11/16) of the lavage group cases and in 23.5% (4/17) of the conventional group (p < 0.05). The mean hospital stay duration was 20.5 ± 14.2 days in the lavage group, whereas it was 39.7 ± 16.9 days in the conventional group (p < 0.05).CONCLUSIONSVentricular lavage or irrigation together with antibiotics is useful in the management of cerebral ventriculitis and associated with a better outcome and shorter hospital stay duration compared to current conventional lines of treatment.

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“…Fluid-debris differential attenuation has disappeared compared to Fig.1 and Fig.2. Although antibiotics are primary treatment of pyocephalus, multiple factors like emergence of multidrug resistance strain of gram negative bacteria, poor CNS penetration of IV antibiotics, and impaired drainage of infected CSF result in Figure 5: Child at 6 months of age weight in order to gain better precondition for VP shunting as to say it has the secondary benefit to alleviate further VP shunt treatment 7,11 .…”

Section: Discussionmentioning

confidence: 99%

Neuroendoscopic lavage and continuous drainage of ventricles: Treatment of pyocephalus in a newborn

2019

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Pyocephalus/Cerebral ventricular empyema is a serious life threatening complication of acute pyogenic meningitis. The primary treatment of ventriculitis is administration of antibiotics. With recent advances, neuroendoscopic lavage (NEL) of ventricles through direct visualization has helped save lives when multipronged approaches including intravenous (IV) antibiotics, intrathecal antibiotics and continuous drainage of cerebrospinal fluid (CSF) fails.We report a case of a 23-day old neonate who developed pyocephalus as a complication of pyogenic meningitis. He did not respond favorably to initial IV antibiotic treatment for two weeks. NEL of ventricles was performed. Thick pus/flakes inside the ventricles had caused obstructive hydrocephalus. Continuous CSF drainage was done through strategically placed multiple external ventricular drains. Interval ventriculo-peritoneal shunt was done bilaterally after the CSF was macroscopically/ microscopically clear of visible debris, and sterile. Microbiological and clinical cure was achieved and the child survived and is thriving well at last follow-up at the age of 6 months.

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Effectiveness of neuroendoscopic ventricular irrigation for ventriculitis

Cited by 22 publications

References 9 publications

Neuroendoscopic aspiration and lavage of intraventricular empyema following shunt infection in infants

Neuroendoscopic aspiration and lavage of intraventricular empyema following shunt infection in infants

Outcome improvement in cerebral ventriculitis after ventricular irrigation: a prospective controlled study

Neuroendoscopic lavage and continuous drainage of ventricles: Treatment of pyocephalus in a newborn

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