Ventricular lavage (VeLa) for ventriculitis: A systematic review of techniques and meta-analysis of outcomes

Ventriculitis is a severe complication of cerebrospinal fluid (CSF) diversion procedures associated with high morbidity and mortality despite advances in antimicrobial therapy. Ventricular lavage (VeLa) has emerged as a potential adjunctive intervention to improve infection clearance and neurological outcomes.

This study aimed to systematically review the surgical techniques of VeLa and evaluate its effectiveness in the treatment of ventriculitis compared with conventional therapy alone.

A systematic review and meta-analysis were conducted according to PRISMA guidelines. Electronic databases were searched from inception to August 2025. Studies describing VeLa for ventriculitis were included. Data on surgical techniques, perioperative variables, complications, and clinical outcomes were extracted. Quantitative synthesis was performed using a random-effects model in RevMan.

Twenty-seven studies were included in the qualitative synthesis and five in the meta-analysis, comprising one randomized controlled trial and four cohort studies. Common techniques involved ventricular access through Kocher's point, endoscope-assisted septostomy, high-volume irrigation until clear effluent, and antibiotic-enriched lavage solutions. Compared with conventional therapy alone, VeLa was associated with lower mortality and improved functional outcomes, including higher odds of achieving a modified Rankin Scale score <3. VeLa also significantly reduced in-hospital parameters including drain duration, hospital stay, and duration of intravenous antibiotic therapy. Reported complications were infrequent and generally manageable.

VeLa may be associated with improved survival and functional recovery, as well as shorter hospitalization and antibiotic duration, when used as an adjunct to conventional treatment for ventriculitis. However, the limited and predominantly observational evidence, together with methodological heterogeneity, precludes definitive conclusions. These findings should be considered hypothesis-generating and warrant validation through larger, well-designed multicenter prospective studies using standardized treatment protocols.