Endoscopic Ventricular Lavage in Pediatric Pyogenic Cerebral Ventriculitis Associated with Shunt: Outcomes and Technical Notes.

Autor: Abdala-Vargas NJ; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Universitario Infantil de San José, Bogotá, Colombia. Electronic address: abdalaneurosurgery@gmail.com., Pulido P; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Universitario Infantil de San José, Bogotá, Colombia., Baquero-Herrera PE; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Universitario Infantil de San José, Bogotá, Colombia., Ordoñez-Rubiano EG; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia., Rincón N; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia., Chávez-Chávez J; Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia., Castaneda-Duarte M; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Universitario Infantil de San José, Bogotá, Colombia., Fernanda-Figueredo L; Department of Psychiatry, NYU Lancome Health, New York, New York; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital de San José, Bogotá, Colombia., Cifuentes HA; Department of Neurological Surgery, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Universitario Infantil de San José, Bogotá, Colombia.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Jun; Vol. 186, pp. e87-e94. Date of Electronic Publication: 2024 Mar 13.
DOI: 10.1016/j.wneu.2024.03.022
Abstrakt: Objective: Pyogenic cerebral ventriculitis (PCV) is a rare infectious entity characterized by a potent inflammatory reaction of the ventricular ependyma, which in most cases leads to death. We aim to present the technical note and protocol, based on our center's 10-year experience of the use of endoscopic ventricular lavage (EVL) in pediatric patients with PCV and ventricular peritoneal shunt.
Methods: For this study, all pediatric patients (<16 years) with VP shunts and PCV who were treated with EVL between January 2012 and January 2022 were included.
Results: Thirty-four pediatric patients with ventriculitis were analyzed. The median age was 6 years, with 61.7% being male. Most consultations occurred on Day 2 of symptoms. Fever (38.2%) and altered consciousness (26.5%) were the most common initial symptoms. Early ventriculitis was observed in 67.7% of patients. Pathogen identification in the initial cerebrospinal fluid sample was 70.6%, while samples from ventricular peritoneal shunt yielded 23.53% and catheter culture 79.4%. Gram-positive bacteria, mainly S.epidermidis (44.1%), was the most commonly isolated agent. EVL was performed in 73.5% on the second or third day. Reinfection occurred in 23.5%, and 26.5% of patients died. Concordance analysis showed 85.3% agreement between LP and catheter tip samples. Functionality improved, with 55.88% achieving a Lansky score of 90. Early ventriculitis was associated with better Lansky scores.
Conclusion: EVL can be a useful tool in the management of PCV in cases with VP shunts. Our study suggests a higher chance of isolating an infection-causing germ in the catheter tip culture specimen compared to the cerebrospinal fluid culture. However, future studies with a larger number of patients, or multicentric studies are required for further analysis.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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