Top

Child's Nervous System

Published in:

01-10-2018 | Special Annual Issue

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

Authors: C. Gaderer, A. Schaumann, M. Schulz, U. W. Thomale

Published in: Child's Nervous System | Issue 10/2018

Abstract

Objective

The treatment of infectious CSF condition with ventriculitis and hydrocephalus in children is an interdisciplinary challenge. Conventional surgical treatment includes external ventricular drain (EVD) and systemic antibiotic therapy. However, infectious contamination of large ventricles combined with CSF protein overload often requires long treatment regimens. We retrospectively investigated neuroendoscopic lavage as a new option for clearance of CSF in children with hydrocephalus and active CSF infection.

Patients and methods

A database review identified 50 consecutive patients treated for CSF infection with hydrocephalus at our institution. Twenty-seven patients (control group, CG) were treated conventionally between 2004 and 2010, while 23 patients (neuroendoscopic group, NEG) underwent neuroendoscopic lavage for removal of intraventricular debris between 2010 and 2015. Clinical data, microbiology, laboratory measures, shunt dependency, and shunt revision rate were evaluated retrospectively.

Results

The patient groups did not differ regarding basic clinical characteristics. Patients in NEG received neuroendoscopic lavage at mean of 1.6 ± 1times (1–4). No immediate postoperative complications were observed in NEG patients. Shunt rate in NEG patients was 91% as compared 100% in CG patients (p = 0.109). Within 24 months after shunt implantation, incidence of shunt revision was higher in CG (23/27) compared to NEG (5/23; p < 0.001). Reinfection was observed more often in CG (n = 17) compared to one patient in NEG (p < 0.001).

Conclusions

We experienced that neuroendoscopic lavage is a safe and effective treatment for hydrocephalus in children with infectious conditions. Neuroendoscopic lavage resulted in a decreased number of overall shunt revisions in shunt-depended patients as well as a lower number of recurrent infections.

Kulkarni AV, Riva-Cambrin J, Butler J, Browd SR, Drake JM, Holubkov R, Kestle JR, Limbrick DD, Simon TD, Tamber MS, Wellons JC 3rd, Whitehead WE, Hydrocephalus Clinical Research N (2013) Outcomes of CSF shunting in children: comparison of Hydrocephalus Clinical Research Network cohort with historical controls: clinical article. J Neurosurg Pediatr 12:334–338CrossRefPubMed

Lazareff JA, Peacock W, Holly L, Ver Halen J, Wong A, Olmstead C (1998) Multiple shunt failures: an analysis of relevant factors. Childs Nerv Syst 14:271–275CrossRefPubMed

Nagy A, Bognar L, Pataki I, Barta Z, Novak L (2013) Ventriculosubgaleal shunt in the treatment of posthemorrhagic and postinfectious hydrocephalus of premature infants. Childs Nerv Syst 29:413–418CrossRefPubMed

Tabuchi S, Kadowaki M (2015) Neuroendoscopic surgery for ventriculitis and hydrocephalus after shunt infection and malfunction: preliminary report of a new strategy. Asian J Endosc Surg 8:180–184CrossRefPubMedPubMedCentral

Kumar A, Agrawal D, Sharma BS (2016) The role of endoscopic lavage in recalcitrant multidrug-resistant gram-negative ventriculitis among neurosurgical patients. World Neurosurg 93:315–323CrossRefPubMed

Schulz M, Buhrer C, Pohl-Schickinger A, Haberl H, Thomale UW (2014) Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates. J Neurosurg Pediatr 13:626–635CrossRefPubMed

d’Arcangues C, Schulz M, Buhrer C, Thome U, Krause M, Thomale UW (2018) Extended experience with neuroendoscopic lavage for posthemorrhagic hydrocephalus in neonates. World Neurosurg

Thomale UW, Gebert AF, Haberl H, Schulz M (2013) Shunt survival rates by using the adjustable differential pressure valve combined with a gravitational unit (proGAV) in pediatric neurosurgery. Childs Nerv Syst 29:425–431CrossRefPubMed

Haberl EJ, Messing-Juenger M, Schuhmann M, Eymann R, Cedzich C, Fritsch MJ, Kiefer M, Van Lindert EJ, Geyer C, Lehner M, Rohde V, Stroux A, von Berenberg P (2009) Experiences with a gravity-assisted valve in hydrocephalic children. Clinical article. J Neurosurg Pediatr 4:289–294CrossRefPubMed

10.

Hanlo PW, Cinalli G, Vandertop WP, Faber JA, Bogeskov L, Borgesen SE, Boschert J, Chumas P, Eder H, Pople IK, Serlo W, Vitzthum E (2003) Treatment of hydrocephalus determined by the European Orbis sigma valve II survey: a multicenter prospective 5-year shunt survival study in children and adults in whom a flow-regulating shunt was used. J Neurosurg 99:52–57CrossRefPubMed

11.

McGirt MJ, Leveque JC, Wellons JC 3rd, Villavicencio AT, Hopkins JS, Fuchs HE, George TM (2002) Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience. Pediatr Neurosurg 36:248–255CrossRefPubMed

12.

Constantini S, Sgouros S, Kulkarni A. Neuroendoscopy in the youngest age group World Neurosurg 79:S23 e21–S23 e11, 2013

13.

Kestle JR, Garton HJ, Whitehead WE, Drake JM, Kulkarni AV, Cochrane DD, Muszynski C, Walker ML (2006) Management of shunt infections: a multicenter pilot study. J Neurosurg 105:177–181PubMed

14.

Bayston R, Rickwood AM (1981) Factors involved in the antibiotic treatment of cerebrospinal fluid shunt infections. Z Kinderchir 34:339–345PubMed

15.

James HE, Bradley JS (2008) Aggressive management of shunt infection: combined intravenous and intraventricular antibiotic therapy for twelve or less days. Pediatr Neurosurg 44:104–111CrossRefPubMed

16.

Tamber MS, Klimo P Jr, Mazzola CA, Flannery AM, Pediatric Hydrocephalus Systematic R, Evidence-Based Guidelines Task F (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 8: management of cerebrospinal fluid shunt infection. J Neurosurg Pediatr 14(Suppl 1):60–71CrossRefPubMed

17.

Schulz M, Buhrer C, Spors B, Haberl H, Thomale UW (2013) Endoscopic neurosurgery in preterm and term newborn infants—a feasibility report. Childs Nerv Syst 29:771–779CrossRefPubMed

18.

Terada Y, Mineharu Y, Arakawa Y, Funaki T, Tanji M, Miyamoto S (2016) Effectiveness of neuroendoscopic ventricular irrigation for ventriculitis. Clin Neurol Neurosurg 146:147–151CrossRefPubMed

19.

Basaldella L, Marton E, Fiorindi A, Scarpa B, Badreddine H, Longatti P (2012) External ventricular drainage alone versus endoscopic surgery for severe intraventricular hemorrhage: a comparative retrospective analysis on outcome and shunt dependency. Neurosurg Focus 32:E4CrossRefPubMed

20.

Etus V, Kahilogullari G, Karabagli H, Unlu A (2018) Early endoscopic ventricular irrigation for the treatment of neonatal posthemorrhagic hydrocephalus: a feasible treatment option or not? A multicenter study. Turk Neurosurg 28:137–141PubMed

21.

Miyajima M, Shimoji K, Watanabe M, Nakajima M, Ogino I, Arai H (2012) Role of artificial cerebrospinal fluid as perfusate in neuroendoscopic surgery: a basic investigation. Acta Neurochir Suppl 113:103–107CrossRefPubMed

22.

Fujita Y, Doi K, Harada D, Kamikawa S (2010) Modulation of physiological hemostasis by irrigation solution: comparison of various irrigation solutions using a mouse brain surface bleeding model. J Neurosurg 112:824–828CrossRefPubMed

Title: Neuroendoscopic lavage for the treatment of CSF infection with hydrocephalus in children
Authors: C. Gaderer
A. Schaumann
M. Schulz
U. W. Thomale
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 10/2018
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-018-3894-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objective

Patients and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Patients and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2018

Management of brain abscesses: where are we now?

Posterior cranial fossa and spinal local infections

Pediatric neurocysticercosis

Shunt infections: a review and analysis of a personal series

Pediatric spinal infections—a review of non-tuberculous infections

The spectrum of tuberculosis of the spine in pediatric age group: a review