Treatment of Pyogenic Ventriculitis with Retroauricular External Ventricular Drainage

Pyogenic ventriculitis (PV) and intraventricular empyema (IVE) are severe intracranial infections with high morbidity and mortality rates. Currently, there is no standardized treatment strategy for these conditions. Existing therapeutic approaches, including neuroendoscopic lavage, repeated external ventricular drainage (EVD), and long-tunneled EVD, each have their respective limitations. Building on the theories of long-tunneled EVD, we developed the retroauricular external ventricular drainage (RaEVD) technique. This study aims to assess the clinical effectiveness and safety of RaEVD in patients with PV and IVE.

RaEVD was performed under local anesthesia using a standard 10-Fr (3.3 mm) EVD catheter, with the distal exit positioned in the non-hair-bearing retroauricular region. This retrospective single-center study included 7 patients (9 RaEVD procedures). Clinical outcomes, drainage duration, complications, and outcomes, as measured by the modified Rankin Scale (mRS), were analyzed.

The median drainage duration was 23 days (interquartile range [IQR]: 14-30 days). No catheter-related infections, cerebrospinal fluid leakage, or dislodgment occurred. The median mRS score improved from 4 (IQR, 4-5) preoperatively to 1 (IQR, 0-6) postoperatively. Five patients received ventriculoperitoneal shunts. Four patients (57.1%) achieved favorable outcomes (mRS 0-1). Two patients died (mortality rate: 28.6%).

RaEVD appears to be a safe and effective technique for managing PV and IVE, with potential advantages in prolonged drainage duration, catheter patency, and procedural simplicity. Future studies with larger cohorts and longer follow-up periods are needed to further validate its effectiveness.