Ventricular lavage versus conservative treatment in cerebral ventriculitis outcomes: a systematic review

Cerebral ventriculitis is a severe intraventricular infection with mortality rates of 30-71% despite standard treatment with antibiotics and external ventricular drainage (EVD). Ventricular lavage (VL) has emerged as an adjunctive therapy, but its comparative effectiveness remains uncertain. We aimed to systematically compare outcomes between VL and conservative management in cerebral ventriculitis.

We conducted a PRISMA-compliant systematic review of PubMed/MEDLINE, Cochrane Library, and ClinicalTrials.gov through January 2025, including 10 studies (n = 322 patients).

VL demonstrated significantly better outcomes across all measured parameters. Mortality was lower with VL (0-25%) versus conservative treatment (23.5-52.9%; p < 0.05 in comparative studies). Hospital stays were 22-50% shorter with VL (20.5-59 vs. 39.7-81 days). Neurological outcomes favored VL, with 66.7-68.8% achieving mRS ≤ 3 versus 23.5-25% in controls. CSF parameters normalized faster with VL (leukocytes: 4 vs. 12 days; protein: 12.9 vs. 27.2 days). VL reduced shunt dependency (56-91% vs. 100%) and infections (2 vs. 7 cases).

Ventricular lavage significantly improves survival, accelerates recovery, and reduces complications compared to conservative management. While current evidence is limited by study heterogeneity, the consistent positive outcomes support consideration of VL for cerebral ventriculitis. Larger randomized trials are needed to optimize protocols and confirm these benefits.