Evaluation of Endoscopic Ventricular Lavage in Management of Infected Hydrocephalus in Infants

Abstract

Background: The management of infected hydrocephalus with bacterial ventriculitis or post ventriculoperitoneal shunt infection in infants is an interdisciplinary challenge. Conventional surgical treatment includes external ventricular drain (EVD) and long duration systemic antibiotic therapy. However, infectious contamination of large ventricles combined with CSF protein overload often requires long treatment regimens. We study the outcome of neuroendoscopic lavage (NEL) as a new option for clearance of CSF in infants with infected hydrocephalus.

Aim and objectives: study the outcome of use of endoscopic ventricular lavage in management of infected hydrocephalus in infants following ventriculoperitoneal shunt infection, cranial taping and bacterial ventriculitis post-surgical procedures.

Patient and methods: This prospective study was conducted in Al- Azhar University Hospitals. This study was conducted on infants with infected hydrocephalus from June\2022 to December\2023.

Result: The study analyzed 14 patients aged 4-21 months, with 8 male patients (57.14%). Follow-up included daily measurement of head circumference, serum CRP and leukocyte level, CSF protein, cell count, and lactate and glucose measures were performed every second day. ongoing signs of active hydrocephalus. The NEL produced a significant improvement (p= <.001) in, fever, bulging fontanel, and head circumference compared to pre-NEL. Pre-NEL Laboratory investigations revealed significant differences (p= <0.001) in ESR, CRP, TLC, CSF glucose, proteins, cellularity, and infected organism compared to post-NEL. However, no significant differences were found in infected organisms or CSF infected organisms. The study population showed significant differences in pre-NEL neurological assessment, laboratory findings, and CSF examinations compared to post-NEL.

Conclusion: the use of endoscopic ventricular lavage in managing infected hydrocephalus in infants. showed significant differences in fever, head circumference percentile, ESR and CRP, TLC and CSF examinations & neurological assessments between pre & post NEL associated with a better outcome and shorter hospital stay duration compared to current conventional lines of treatment.