Neuroendoscopic Ventricular Irrigation for Ventriculitis

Ventriculitis carries a high  mortality and morbidity, even with prompt diagnosis and treatment with antibiotics.  A retrospective study from Kyoto Univeristy Graduate School of Medicine concluded that neuroendoscopic irrigation effectively treats ventriculitis, with lower mortality and duration of drainage catheter compared to historical control.  The study population was small and the design was retrospective.  Larger, prospective studies are needed to confirm these promising initial results.

Since 2011, this institution has adopted neuroendoscopic irrigation as standard treatment for ventriculitis.  After diagnosis on MRI (high intensity on DWI and gad enhancement of ventricular lining), antibiotics was started and neuroendoscopic irrigation was performed, followed by drainage catheter insertion.  Intraparenchymal abscess </=3cm in diameter was treated by placement of drainage catheter (without irrigation).  Abscesses >3cm was surgically evacuated.

Method of Neuroendoscopic Irrigation:

An oval-shaped Burr hole was created in the left frontal bone for insertion of 2 drainage tubes.  One tube was advanced into the abscess and the other was placed in the lateral ventricle under neuronavigator guidance.  Pus was aspirated from the intraparenchymal abscess.  A sheath was introduced to the lateral ventricle along with the ventricular drainage.  Artificial CSF was flushed through the drainage tube.  Ventricle was inspected with a rigid neuroendoscope, and white material suspended in the CSF was irrigated out.  After sufficient irrigation, structures around foramen of Monro (initially covered by white material) were visualized.  Under endoscopic guidance, the tip of drainage tube was placed at the posterior part of the lateral ventricle.

Capture.JPG

(a) Lateral ventricle filled with white, sticky material;  (b) ventricular wall and choroid plexus (arrow) covered with grayish infectious material; (c) normal structures, choroid plexus (arrow), visualized after irrigation

 

Reference

Terada, Yukie et al. “Effectiveness Of Neuroendoscopic Ventricular Irrigation For Ventriculitis”.Clinical Neurology and Neurosurgery 146 (2016): 147-151.

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