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

Abstract

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.