Application of endoscopic neurosurgery in diagnosis and treatment of ventriculitis

Objective To explore the role of endoscopic neurosurgery in the diagnosis and treatment of ventriculitis. Methods A retrospective study was conducted on the clinical data of 21 patients with ventriculitis who underwent neuroendoscopic diagnosis and treatment at 6 medical center including Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University from March 2010 to March 2017. Infection of the ventricular system was divided into Ⅰ-Ⅳ types based on the neuroendoscopic assessment. Neuroendoscopic surgical techniques was applied to incise the intraventricular compartment and reconstruct cerebrospinal fluid circulation, obliterate intraventricular debris and pus and remove artificial implanted materials. Perioperatively intraventricular antibiotics were administered according to the type of infection and the results of bacterial culture. Endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt was performed for secondary hydrocephalus. Results There were 6 cases of type Ⅰ, 7 cases of type Ⅱ, 4 cases of type Ⅲ and 4 cases of type Ⅳ. One (4.8%) died of multiple organ failure. Twenty (95.2%) cases of ventriculitis fully recovered. Among the 16 cases with secondary hydrocephalus, 11 cases underwent ventriculoperitoneal shunt and 5 cases underwent ETV. ETV was ineffective in 1 case and ventriculoperitoneal shunt was then performed for the case. During the follow-up with a median of 25.5 months (5-60 months), there was no recurrence and the surgical effects were satisfactory. Conclusions Application of neuroendoscopic techniques seem effective for the diagnosis, assessment and treatment of ventriculitis. In addition, perioperative lavage of the ventricular system with antibiotic saline might be of importance. Key words: Natural orifice endoscopic surgery; Cerebral ventricles; Infection; Diagnosis; Therapy