We report 2 cases presenting ventriculitis, which were effectively treated by neuroendoscopic surgery. A 70-year-old woman showed progressing consciousness disturbance 18 days after clipping surgery for ruptured aneurysm of the middle cerebral artery. Computed tomography (CT) revealed fluid-fluid level layering in the lateral ventricles. Irrigation with antibiotics was not effective to control intraventricular infection. Resection of membranes created in the ventricle and evacuation of debris were performed using a neuroendoscope. A ventricular drainage was implanted in the posterior horn of the lateral ventricle. The cerebrospinal fluid data was improved immediately, and ventriculoperitoneal shunt was successful. A 31-year-old man deteriorated his consciousness level 6 days after pneumocephalus and skull base fracture caused by head trauma. CT demonstrated a marked ventriculomegaly. Unilateral ventricular drainage decreased a size of the ipsilateral ventricle, but contralateral ventricle remained to be enlarged. Neuroendoscopic irrigation of the ventricle and evacuation of debris were performed. After the CSF data was improved, septostomy of the septum pellucidum was performed with ventriculoperitoneal shunt, because stenosis of the foramen of Monro was observed. Neuroendoscopic treatment, including resection of the membrane and septum created in the ventricles and evacuation and irrigation of infectious debris, could be attempted with minimally invasive technique, and has advantage of spontaneous external drainage and irrigation. We believe that the endoscopic intervention should be considered as the initial treatment option.
ASJC Scopus subject areas
- Clinical Neurology