Effectiveness of neuroendoscopic ventricular irrigation for ventriculitis

• Ventriculitis is associated with a long treatment course and poor clinical outcome.
• We compared outcomes of neuroendoscopic ventricular irrigation and other treatments.
• Early neuroendoscopy led to a shorter period of drain placement.

ObjectivesVentriculitis is an uncommon condition with a poor prognosis, especially when complicated by brain abscess. We compared the therapeutic efficacy of neuroendoscopic ventricular irrigation with those of conventional treatments such as ventricular drainage and continuous irrigation via a ventricular drain.Patients and methodsWe retrospectively analyzed 14 consecutive patients treated for ventriculitis at our institution between 2001 and 2015. Included were the six patients treated with neuroendoscopic (NE) irrigation (NE group), which we adopted in 2011, and the eight patients treated before 2011 with conventional treatments (non-NE group). We compared mortality, modified Rankin Scale (mRS) score 6 months postoperatively, and duration of ventricular/spinal drainage-catheter placement between groups.ResultsMean age at onset was 49.3 years (range, 32–68 years) in the NE group and 50.3 years (range, 8–78 years) in the non-NE group. At 6-month follow-up, good clinical outcome (mRS ≤ 3) was observed in 66.7% of the NE group, whereas it was observed in 25.0% of the non-NE group. There were three deaths (37.5%) in the non-NE group but none in the NE group. Duration of drainage-catheter placement was significantly shorter in the NE group than in the non-NE group (19.8 days vs. 70.9 days, p < 0.001). Among patients in the NE group, only those who underwent irrigation on the day of diagnosis maintained a low mRS score.ConclusionNeuroendoscopic ventricular irrigation was safe and effective in the treatment of ventriculitis. Immediate intervention after diagnosis may lead to an improved prognosis.