Clinical effect of radical debris evacuation with a flexible neuroendoscope on patients with ventriculitis: a case series.

Abstract

Background: Ventriculitis is a severe infectious disease affecting the entire ventricular system and is associated with high mortality and morbidity, particularly due to the subsequent development of hydrocephalus. Although most patients are treated with external ventricular drainage or ventricular irrigation, the impact of radical debris evacuation on clinical outcomes has not been well examined.

Case presentation: This study included 11 Japanese patients with ventriculitis treated at Tohoku University Hospital or Kohnan Hospital between January 2000 and December 2020. Of these, eight were male and three were female, with ages ranging from 24 to 88 years (median: 52 years). The following variables were retrospectively analyzed using a computerized neuroendoscopy patient database: age, sex, etiology of ventriculitis, initial ventriculitis treatment, presence of hydrocephalus, and the duration between the initial surgery and additional treatment for hydrocephalus. Among the 11 patients, 6 were treated with external ventricular drainage, while 5 underwent radical debris evacuation with a neuroendoscope. Cerebrospinal fluid diversion surgery for hydrocephalus was required in five of six (83.3%) patients treated with external ventricular drainage and three of five (60%) patients treated with neuroendoscopic debris evacuation. The time interval between the initial treatment for ventriculitis and shunt surgery was significantly shorter in patients who underwent radical debris evacuation (12.7 ± 6.5 days) than in those treated with external ventricular drainage (72.2 ± 52.5 days).

Conclusion: Neuroendoscopic radical debris evacuation in patients with ventriculitis may shorten the duration between the initial treatment and shunt surgery and potentially reduce the proportion of patients requiring shunt surgery. This effect is likely due to the attenuation of ventricular inflammation, contributing to improved clinical outcomes.