Management of Pyogenic Cerebral Ventriculitis by Neuroendoscopic Surgery

Abstract Background Pyogenic cerebral ventriculitis is a debilitating form of intracranial infection with an unfavorable outcome due to lack of experience in surgical management. Objective To study retrospectively a group of pyogenic cerebral ventriculitis patients managed by neuroendoscopic surgery (NES). Methods The standard intraventricular protocols of NES to treat this disease included 1 or more of the following: (1) to obliterate debris, (2) to observe evidence of microbial infection, (3) to perform septomy, (4) to incise the septation, or (5) to monitor catheter insertion. Modified EVD (mEVD) was combined with NES when intraventricular debris and bacterial plaques could not be evacuated completely. Subsequent surgical treatment strategies depended on the clinical manifestation, CSF analysis, and mEVD blockage tests approximately 3 weeks after the last NES. Results Forty-one patients, who were distributed in 7 hospitals and underwent NES, were included. Five patients received 1 NES, 18 received 2, 16 received 3, and 2 received 4. mEVD was performed in all patients, and mean mEVD duration in the hospital was 27.6 days. At discharge, 15 patients were cured, 15 were cured but V-P shunt-dependent, 9 were mEVD-dependent, and 2 died (mean mRS was 2.48). Two mEVD-dependent patients died, and no other outcomes changed during post-operative follow-up (mean mRS was 2.67). Conclusion The results suggest a relatively favorable outcome for management of pyogenic cerebral ventriculitis by NES. The techniques and strategies are practical and should be applied more extensively.