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双腔导管系统的立体定向置入用于脑脓肿合并脑室炎的持续引流、冲洗及脑室内抗生素治疗——病例报告及文献综述

Stereotactic placement of dual lumen catheter system for continuous drainage, irrigation, and intraventricular antibiotic therapy for treatment of brain abscess with ventriculitis - A case report and literature review.

作者信息

Policicchio Domenico, Cosco Lucio, Mauro Giuseppe, Iannello Alfonso Nicola, Santaguida Luigi, Vescio Virginia, Dipellegrini Giosué

机构信息

Department of Neurosurgery, Azienda Ospedaliero Universitaria Renato Dulbecco di Catanzaro, Catanzaro, Italy.

Unit of Infectious and Tropical Diseases, Azienda Ospedaliero Universitaria "Renato Dulbecco" di Catanzaro, Catanzaro, Italy.

出版信息

Surg Neurol Int. 2024 Feb 23;15:57. doi: 10.25259/SNI_977_2023. eCollection 2024.

Abstract

BACKGROUND

Cerebral abscesses complicated by ventriculitis present significant treatment challenges, often associated with high morbidity and mortality. Traditional management approaches, including systemic antibiotic therapy and external ventricular drainage (EVD), face limitations due to the blood-brain barrier and risks of catheter-related complications. This report discusses a case where the dual-lumen catheter system, an innovative neurosurgical tool integrating continuous irrigation with drainage, was employed.

CASE DESCRIPTION

A patient presented with a cerebral abscess ruptured into the ventricle, leading to ventriculitis. Conventional treatment options were limited due to the abscess's deep and eloquent location and the associated risk of complications from standard EVD. The dual lumen system was chosen for its ability to provide continuous irrigation and drainage, effectively addressing issues of catheter blockage and enhancing localized antibiotic delivery. The system was used to create a single stereotactic tract for simultaneous treatment of the abscess and ventriculitis. This approach allowed for a more controlled and effective treatment process, resulting in rapid resolution of the conditions without chronic hydrocephalus development or further complications.

CONCLUSION

The use of the dual lumen system represented a significant advancement in this case, addressing the limitations of conventional treatments. Its ability to maintain intracranial pressure within optimal limits while providing localized, continuous treatment was pivotal. This case highlights the potential of the dual lumen catheter in managing complex neurosurgical infections and underscores the need for further research to establish its efficacy in broader clinical applications.

摘要

背景

脑脓肿合并脑室炎带来了重大的治疗挑战,常伴有高发病率和死亡率。传统的治疗方法,包括全身抗生素治疗和外部脑室引流(EVD),由于血脑屏障以及导管相关并发症的风险而面临局限性。本报告讨论了一个病例,其中采用了双腔导管系统,这是一种将持续冲洗与引流相结合的创新神经外科工具。

病例描述

一名患者出现脑脓肿破入脑室,导致脑室炎。由于脓肿位置深且功能区明确,以及标准EVD相关的并发症风险,传统治疗选择有限。选择双腔系统是因为其能够提供持续冲洗和引流,有效解决导管堵塞问题并增强局部抗生素递送。该系统用于创建单一的立体定向通道,同时治疗脓肿和脑室炎。这种方法实现了更可控、有效的治疗过程,使病情迅速得到缓解,未出现慢性脑积水或进一步并发症。

结论

在该病例中,双腔系统的使用代表了一项重大进展,克服了传统治疗的局限性。其在提供局部、持续治疗的同时将颅内压维持在最佳限度内的能力至关重要。该病例凸显了双腔导管在处理复杂神经外科感染方面的潜力,并强调需要进一步研究以确定其在更广泛临床应用中的疗效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dec9/10927178/afbd05178697/SNI-15-57-g001.jpg

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