Endoscopic ventricular irrigation for treatment of ventricular infection

Objective To study the effect of endoscopic ventricular irrigation for the treatment of ventricular infection. Methods 60 cases of ventricular infection were treated with endoscopic ventricular irrigation under flexible neuron-endoscope from Febrary, 2007 to November,2009. Among them, 41 cases were secondary to V-P shunt, 13 cases were secondary to external ventricular drainage due to intraventricular hemorrhage or traumatic hydrocephalus, 4 cases were secondary to other neurosurgical operations and 2 case was due to tuberculous meningitis. Results Of all the 60 patients, 25 (42%) were negative in CSF bacterial culture, 27(45%) were infected with general pyogenic bacteria such as staphylococci, streptococcus pneumoniae, Enterococcus faecalis, Klebsiella pneumoniae, Escherichia coli,Acinetobacter baumannii. 3(5%) were infected with Pseudomonas aeruginosa, 3(5%) were fungal infection, 2(3%) were infected with tubercle bacillus. 26(43%) cases of ventricular infection were cured with successful removal of shunt or external ventricular drainage (EVD) by single endoscopic ventricular irrigation. 34(57%) patients whose endoscopic ventricular irrigation were followed by EVD andintraventricular injection of antibiotics, the EVD duration was 4 to 76 d (mean 20.1 d). The second V-P shunt was not avoided due to intracranial hypertension after removal of EVD in 7 (12%) patients. The death rate was 8%. All dead cases were infected with Pseudomonas aeruginosa or fungus which were extensive drug -resistant. Conclusion Severe ventricular infection is troublesome in neurosurgery. Ventricular irrigation under flexible neuron-endoscope could shorten the course and improve the effect of the treatment of severe ventricular infection. Key words: Neuroendoscopy; Ventricular irrigation; Ventricular infection