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Neuroendoscopic lavage for the treatment of CSF infection with hydrocephalus in children

C Gaderer1, A Schaumann1, M Schulz1

  • 1Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|July 12, 2018
PubMed

Insights

Neuroendoscopic lavage offers a safe and effective treatment for pediatric hydrocephalus with infection. This method reduces shunt revisions and recurrent infections compared to conventional treatments.

Area of Science:

  • Pediatric Neurosurgery
  • Infectious Diseases
  • Hydrocephalus Management

Background:

  • Infectious cerebrospinal fluid (CSF) conditions like ventriculitis and hydrocephalus in children present significant treatment challenges.
  • Conventional treatments involving external ventricular drains (EVD) and antibiotics often require prolonged regimens due to CSF protein overload and ventricular contamination.

Purpose of the Study:

  • To retrospectively investigate neuroendoscopic lavage as a novel approach for clearing CSF in pediatric patients with hydrocephalus and active infection.
  • To compare the efficacy and safety of neuroendoscopic lavage with conventional treatment methods.

Main Methods:

  • A retrospective review of 50 pediatric patients with CSF infection and hydrocephalus was conducted.
  • Twenty-seven patients (control group, CG) received conventional treatment (2004-2010), while 23 patients (neuroendoscopic group, NEG) underwent neuroendoscopic lavage (2010-2015).
  • Clinical data, microbiology, laboratory measures, shunt dependency, and shunt revision rates were analyzed.

Main Results:

  • No significant difference in basic clinical characteristics was observed between the groups.
  • Neuroendoscopic lavage patients (NEG) experienced fewer shunt revisions (5/23) compared to the control group (CG) (23/27) within 24 months post-implantation (p < 0.001).
  • Reinfection rates were significantly lower in the NEG (1 patient) compared to the CG (17 patients) (p < 0.001).

Conclusions:

  • Neuroendoscopic lavage is a safe and effective treatment for pediatric hydrocephalus associated with infectious conditions.
  • This technique leads to a reduced number of shunt revisions in shunt-dependent patients.
  • Neuroendoscopic lavage also demonstrates a lower incidence of recurrent infections.
Abstract

Keywords:
Cerebrospinal fluidExternal ventricular drainageHydrocephalusInfectionNeuroendoscopic lavageNeuroendoscopyVentriculo peritoneal shunt

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