Continuous intraventricular lavage using the IRRAflow® System in refractory ventriculitis in a pediatric patient: A...

Ventriculitis in patients with complex, multiloculated hydrocephalus and a history of multiple shunt revisions represents a formidable challenge. Conventional external ventricular drain (EVD) systems are frequently limited by obstruction from purulent material, requiring repeated manual irrigation, which compromises infection control, intracranial pressure (ICP) stability, and superinfection. Novel technologies integrating continuous, controlled irrigation with simultaneous drainage offer a potential solution for refractory cases.

We present the case of a 16-year-old male with posthemorrhagic multiloculated hydrocephalus complicated by ascites and severe refractory ventriculitis due to Pseudomonas aeruginosa. Despite aggressive management, including multiple EVD replacements, endoscopic lavage and aqueductoplasty, two craniotomies for removal of dense fibrinous-caseous material covering the walls of ventricles and evacuation of atemporal lobe brain abscess, the infection persisted for two months. As a salvage measure, a new frontal EVD utilizing the IRRAflow® system was placed. Over the following two weeks of continuous irrigation and active drainage, CSF parameters progressively normalized, resulting in the clearance of inflammatory markers and three consecutive negative microbiological cultures. Sterility allowed successful conversion to a definitive ventriculoatrial shunt.

This case illustrates the limitations of conventional passive drainage in complex ventricular infections and demonstrates the efficacy of the IRRAflow® system. Its ability to provide continuous irrigation and active drainage successfully eliminates refractory Pseudomonas ventriculitis after all standard interventions fail. The IRRAflow® system is a valuable new tool in neurosurgical armamentarium, particularly for complex and persistent intraventricular infections.