Introduction: Pyogenic ventriculitis is a rare but often fatal post-operative complication. Intraventricular empyema formation can lead to progressive obstructive hydrocephalus and rapid decline in neurological function. Even with early diagnosis and management, pyogenic ventriculitis can be resistant to antibiotic treatment as penetration of the purulent debris may be inadequate. Here, we report a novel use of intraventricular neuroendoscopy combined with a side-cutting aspiration device for the successful management of two cases of postoperative pyogenic ventriculitis.
Methods: In the first case, a 24-year-old male with a history of multiple prior surgeries (including three resections, Ommaya catheter placement, and shunt placement) and radiation treatment for craniopharyngioma, developed pyogenic ventriculitis following initial near total craniopharyngioma resection done via an endoscopic endonasal approach. In the second case, a 17-year-old male with a history of multiple prior surgeries and radiation treatment for a 4th ventricular ependymoma underwent gross total resection of the ventricular ependymoma and EVD placement. He subsequently developed pyogenic ventriculitis.
Results: Klebsiella pneumoniae was the source of infection in both cases and was resistant to all medical therapy including intrathecal antibiotics. Given the lack of all other options, a side-cutting aspiration device normally used for tumor surgery was utilized via intraventricular neuroendoscopy. In both cases, source control was successfully achieved by performing salvage neuroendoscopic evacuation of empyema utilizing a side-cutting aspiration device. After source control was obtained, IV antibiotics were utilized to complete the infection clearance.
Conclusions: This is the first report to describe the use of intraventricular neuroendoscopy combined with a side-cutting aspiration device as a successful salvage treatment for pyogenic ventriculitis. Although surgical intervention is not the first choice of treatment for ventriculitis, the procedure described here appears useful for preventing fatality in cases of severe pyogenic ventriculitis when antibiotic treatment alone is insufficient.
Patient Care: The procedure described here appears useful for preventing fatality in cases of severe pyogenic ventriculitis when antibiotic treatment alone is insufficient.
Learning Objectives: By the conclusion of the session, participants will learn how intraventricular neuroendoscopy combined with a side-cutting aspiration device can be successfully used to manage pyogenic ventriculitis resistant to antibiotics treatment.