Gaderer C, Schaumann A, Schulz M, Thomale U W
Pediatric Neurosurgery, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Childs Nerv Syst. 2018 Oct;34(10):1893-1903. doi: 10.1007/s00381-018-3894-7. Epub 2018 Jul 11.
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.
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.
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).
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.
治疗儿童感染性脑脊液疾病合并脑室炎和脑积水是一项跨学科挑战。传统手术治疗包括外部脑室引流（EVD）和全身抗生素治疗。然而，大脑室的感染性污染与脑脊液蛋白过载相结合往往需要长期治疗方案。我们回顾性研究了神经内镜灌洗作为脑积水合并活动性脑脊液感染患儿清除脑脊液的一种新选择。
通过数据库回顾，确定了在我们机构接受脑脊液感染合并脑积水治疗的50例连续患者。27例患者（对照组，CG）在2004年至2010年期间接受传统治疗，而23例患者（神经内镜组，NEG）在2010年至2015年期间接受神经内镜灌洗以清除脑室内碎片。对临床数据、微生物学、实验室指标、分流依赖情况和分流翻修率进行回顾性评估。
两组患者的基本临床特征无差异。NEG组患者平均接受神经内镜灌洗1.6±1次（1 - 4次）。NEG组患者术后未观察到即刻并发症。NEG组患者的分流率为91%，而CG组患者为100%（p = 0.109）。在分流植入后24个月内，CG组（23/27）的分流翻修发生率高于NEG组（5/23；p < 0.001）。CG组（n = 17）的再感染发生率高于NEG组的1例患者（p < 0.001）。
我们发现神经内镜灌洗是治疗感染性疾病患儿脑积水的一种安全有效的方法。神经内镜灌洗使依赖分流的患者总体分流翻修次数减少，再感染次数也减少。
