Neuroendoscopic surgery for ventriculitis and hydrocephalus after shunt infection and malfunction: Preliminary report of a new strategy

Abstract

If not controlled in the early stage, ventriculitis is difficult to treat neurosurgically and can lead to serious sequelae, a long course of treatment, and hospitalization. We report two cases of ventriculitis and progressive hydrocephalus after shunt infection. Both were successfully treated by neuroendoscopic septostomy in combination with thorough intraventricular irrigation through a single burr hole followed by single shunt revision. Although surgical intervention has not been established as a first-choice treatment for ventriculitis, including early-stage ventriculitis, prompt neuroendoscopic surgery appears effective for the management of ventriculitis and hydrocephalus after shunt infection. The strategy described in this report might be useful to avoid recurrent shunt infections and malfunctions, simplify a shunt, and reduce the overall duration of hospitalization.

Treatment of ventriculoperitoneal shunt infection and ventriculitis caused by Acinetobacter baumannii: a case report

“…It can cause neurological defects, and can lead to a long course of treatment and hospitalization. Such infections are serious intracranial infection that can lead to death [ 3 , 4 ].…”

A Case of Invasive Pneumococcal Infection with Septic Shock and Rare Complications

“…There are no particular guidelines for neurosurgical intervention in purulent ventriculitis, and surgical intervention is often deferred as the risk of further infection and other surgical complications is too high. There are a few case reports, especially in pediatric patients, of endoscopic ventricular washouts and drainage in refractory cases, as well as septostomy to restore CSF flow in cases complicated by unilateral hydrocephalus [10, 11]. Tabuchi and Kadowaki (2015) proposed that neurosurgical intervention be considered after two weeks of antibiotic therapy with no improvement [11].…”

“…There are a few case reports, especially in pediatric patients, of endoscopic ventricular washouts and drainage in refractory cases, as well as septostomy to restore CSF flow in cases complicated by unilateral hydrocephalus [10, 11]. Tabuchi and Kadowaki (2015) proposed that neurosurgical intervention be considered after two weeks of antibiotic therapy with no improvement [11]. In patients with simultaneously infected shunts, the shunt is often removed and a new shunt is reimplanted once antibiotic therapy is complete [10].…”

Complex antibacterial and minimally invasive surgical treatment of children with ventriculitis

“…Так, S. Tabuchi, M. Kadowaki (2015) рекомендуют в случае устойчивого к проводимой АБТ вентрикулита, спустя 2 недели от момента постановки диагноза, проведение эндоскопической ревизии желудочковой системы с отмыванием желудочков от сгустков гноя и детрита раствором Рингера или искусственными аналогами ЦСЖ. Выполнение эндоскопической септостомии может быть эффективным при формировании унилатеральной гидроцефалии вследствие закупорки одного из отверстий Монро, а также для ревизии и отмывания от детрита и гноя в контралатеральном боковом желудочке через один доступ к желудочковой системе [14]. F. Wang et al (2017) сообщили об успешном лечении больных с вентрикулитом при выполнении неоднократных эндоскопических ревизий с отмыванием желудочков от сгустков гноя и детрита, рассечением и иссечением образующихся на фоне воспаления септ, с последующим проведением длительного НВД.…”