Neuroendoscopic lavage for ventriculitis: Case report and literature review

Qin, Guowen; Liang, Yinghua; Xu, Kailun; Xu, Peng; Ye, J.; Tang, Xihe; Lan, Shengyong

doi:10.1016/j.neuchi.2019.12.005

Cited by 9 publications

(8 citation statements)

References 21 publications

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“…NEL, like every technique, requires a learning curve to master it. Several articles have been published around the utility of this technique for germinal matrix hemorrhage and ventriculitis [22][23][24]. However, in these articles the technique is described in a general way and, to date, none of them have detailed the tip and tricks around this very specific and complex surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

Technical Nuances in Neuroendoscopic Lavage for Germinal Matrix Hemorrhage in Preterm Infants: Twenty Tips and Pearls after More than One Hundred Procedures

et al. 2021

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Introduction: Posthemorrhagic hydrocephalus in preterm infants is a serious entity related to high mortality and morbidity. Neuroendoscopic lavage (NEL) is a suitable alternative for the management of this pathology. However, as with every endoscopic technique, it requires some experience and several cases to master. Methods: We present a descriptive study of some technical nuances, tips, and tricks that have been learned in the last 8 years with over a hundred NELs performed in preterm infants. These variations are classified into 3 categories according to their temporal relationship with the surgical procedure: preoperative stage, intraoperative stage, and postoperative stage. We include a brief description of each one and the reasons why they are included in our current clinical practice. Results: Twenty tips and pearls were described in detail and are reported here. Preoperative, intraoperative, and postoperative variations were exposed and related to the most frequent complications of this procedure: infection, cerebrospinal fluid leak, and rebleeding. Conclusions: NEL is a useful technique for the management of germinal matrix hemorrhage in preterm infants. These technical nuances have improved the results of our technique and helped us to prevent complications related to the procedure.

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Section: Discussionmentioning

confidence: 99%

Technical Nuances in Neuroendoscopic Lavage for Germinal Matrix Hemorrhage in Preterm Infants: Twenty Tips and Pearls after More than One Hundred Procedures

et al. 2021

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“…183 The technique can be supplemented by a septostomy using biopsy forceps, ventricular lavage with saline, and intraventricular antibiotic administration. 184 Endoscopic evacuation and lavage advantages are safe debris removal, targeted high-flow irrigation and tissue sampling, and microabscess destruction. 184 Endoscopic evacuation and irrigation indications are not clear, and currently, neuroendoscopy has been used to treat primarily purulent meningitis when intravenous antibiotics and EVDs fail.…”

Section: Neurosurgical Perspectivementioning

confidence: 99%

“…184 Endoscopic evacuation and lavage advantages are safe debris removal, targeted high-flow irrigation and tissue sampling, and microabscess destruction. 184 Endoscopic evacuation and irrigation indications are not clear, and currently, neuroendoscopy has been used to treat primarily purulent meningitis when intravenous antibiotics and EVDs fail. 184 The results are frequently encouraging, with a good outcome in most of the cases and moderate results regarding shunt dependence.…”

Section: Neurosurgical Perspectivementioning

confidence: 99%

“…184 Endoscopic evacuation and irrigation indications are not clear, and currently, neuroendoscopy has been used to treat primarily purulent meningitis when intravenous antibiotics and EVDs fail. 184 The results are frequently encouraging, with a good outcome in most of the cases and moderate results regarding shunt dependence. 185,186 However, further high-quality research is required to elucidate the role of neuroendoscopy in managing post-neurosurgical infections.…”

Section: Neurosurgical Perspectivementioning

confidence: 99%

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Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis

Karvouniaris¹,

Brotis²,

Tsiakos³

et al. 2022

IDR

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Ventriculitis or post-neurosurgical meningitis or healthcare-associated ventriculitis and meningitis (VM) is a severe infection that complicates central nervous system operations or is related to the use of neurosurgical devices or drainage catheters. It can further deteriorate patients who have already presented significant neurologic injury and is associated with high morbidity, mortality, and poor functional outcome. VM can be difficult to distinguish from aseptic meningitis, inflammation that follows hemorrhagic strokes and neurosurgical operations. The associated microorganisms can be either skin flora or nosocomial pathogens, most commonly, Gram-negative bacteria. Classical microbiology can fail to isolate the culprit pathogen. Novel cerebrospinal fluid (CSF) biomarkers and molecular microbiology can fill the diagnostic gap and expedite pathogen identification and treatment. The pathogens may demonstrate significant resistant patterns and their antibiotic treatment can be difficult, as many important drug classes, including the beta-lactams and the glycopeptides, hardly penetrate to the CSF, and do not achieve therapeutic levels at the site of the infection. Treatment modifications, such as higher daily dose and prolonged or continuous administration, might increase antibiotic levels in the site of infection and facilitate pathogens clearance. However, in the case of therapeutic failure or infection due to difficultto-treat bacteria, the direct antibiotic instillation into the CSF, in addition to the intravenous antibiotic delivery, may help in the resolution of infection. However, intraventricular antibiotic therapy may result in aseptic meningitis and seizures, concerning the administration of aminoglycosides, polymyxins, and vancomycin. Meanwhile, bacteria form biofilms on the catheter or the device that should routinely be removed. Novel neurosurgical treatment modalities comprise endoscopic evacuation of debris and irrigation of the ventricles. VM prevention includes perioperative antibiotics, antimicrobial impregnated catheters, and the implementation of standardized protocols, regarding catheter insertion and manipulation.

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“…Ventriculitis is a neurosurgical disease with a high mortality rate. The mortality rate of ventriculitis is approximately 30-71%, despite appropriate treatments 1,2) . In 2017, intravenous (IV) injection of antibiotics was suggested as the primary treatment by the Infectious Disease Society of America (IDSA) guidelines.…”

Section: Introductionmentioning

confidence: 99%

Intraventricular Lavage Via Bilateral Extraventricular Lavage: A Case Report and Literatures Review

Kim

Park

et al. 2022

J Neurointensive Care

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Ventriculitis has a poor prognosis, and treatment is technically challenging. We describe a case of ventriculitis in which bilateral continuous extraventricular lavage was performed and review the previously published literature on the treatment of ventriculitis using extra-ventricular drainage (EVD). A 75-year-old woman lost consciousness while undergoing intravenous meropenem treatment for a submandibular abscess. Contrast-enhanced brain magnetic resonance imaging (MRI) revealed ventriculitis and fluid collection with diffusion restriction at both occipital horns of the lateral ventricles and third ventricle that indicate empyema. She was referred to the neurosurgery department for an emergent operation. An extra-ventricular drainage catheter was inserted bilaterally at Kocher’s point. Since ventriculitis was disseminated from the submandibular abscess and intravenous meropenem as empirical antibiotics had been administered, meropenem-mixed saline was continuously dripped through one EVD catheter intraoperatively, and approximately 1 L of saline with antibiotics was drained until grossly clear fluid flowed through the other EVD catheter. MRI was performed 28 days postoperatively, and diffusion-weighted images showed a decrease in restriction, and the cerebrospinal fluid profile appeared to have improved. The ventriculoperitoneal shunt was performed 34 days after EVD lavage due to secondary hydrocephalus. Three months later, the patient was available for cane-gait and is currently undergoing follow-up without neurological complications. Continuous intraoperative lavage through bilateral EVD is relatively simple and maintains more aseptic conditions during the procedure. Although ventriculitis is fetal in patients, bilateral extraventricular lavage can be a relatively safe and effective conventional administration of antibiotics for ventriculitis.

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Neuroendoscopic lavage for ventriculitis: Case report and literature review

Cited by 9 publications

References 21 publications

Technical Nuances in Neuroendoscopic Lavage for Germinal Matrix Hemorrhage in Preterm Infants: Twenty Tips and Pearls after More than One Hundred Procedures

Technical Nuances in Neuroendoscopic Lavage for Germinal Matrix Hemorrhage in Preterm Infants: Twenty Tips and Pearls after More than One Hundred Procedures

Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis

Intraventricular Lavage Via Bilateral Extraventricular Lavage: A Case Report and Literatures Review

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