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Policicchio D, Cosco L, Mauro G, Iannello AN, Santaguida L, Vescio V, Dipellegrini G. 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. Surg Neurol Int 2024; 15:57. [PMID: 38468682 PMCID: PMC10927178 DOI: 10.25259/sni_977_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/22/2024] [Indexed: 03/13/2024] Open
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.
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Affiliation(s)
- Domenico Policicchio
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Renato Dulbecco di Catanzaro, Catanzaro, Italy
| | - Lucio Cosco
- Unit of Infectious and Tropical Diseases, Azienda Ospedaliero Universitaria “Renato Dulbecco” di Catanzaro, Catanzaro, Italy
| | - Giuseppe Mauro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Renato Dulbecco di Catanzaro, Catanzaro, Italy
| | - Alfonso Nicola Iannello
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Renato Dulbecco di Catanzaro, Catanzaro, Italy
| | - Luigi Santaguida
- Unit of Biomedical Engineering, Azienda Ospedaliero Universitaria “Renato Dulbecco” di Catanzaro, Catanzaro, Italy
| | - Virginia Vescio
- Department of Radiology, Azienda Ospedaliero Universitaria “Renato Dulbecco” di Catanzaro, Catanzaro, Italy
| | - Giosué Dipellegrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
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Stati G, Migliorino E, Moneti M, Castioni CA, Scibilia A, Palandri G, Virgili G, Aspide R. Treatment of cerebral ventriculitis with a new self-irrigating catheter system: narrative review and case series. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:46. [PMID: 37941074 PMCID: PMC10631212 DOI: 10.1186/s44158-023-00131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
Cerebral ventriculitis is a life-threatening condition that requires prompt and effective pharmacological intervention. The continuous irrigation of the cerebral ventricles with fluid and its drainage is a system to remove toxic substances and infectious residues in the ventricles; this system is called IRRAflow®. We used this kind of ventricular irrigation/drainage system to treat two patients with post-surgical cerebral ventriculitis and a patient with bacterial meningitis complicated with ventriculitis. In this case series, we discuss the management of these three cases of cerebral ventriculitis: we monitored cytochemical parameters and cultures of the cerebrospinal fluid of patients during their ICU stay and we observed a marked improvement after irrigation and drainage with IRRAflow® system. Irrigation/drainage catheter stay, mode settings, and antibiotic therapies were different among these three patients, and neurological outcomes were variable, according to their underlying pathologies. IRRAflow® system can be applied also in other types of brain injury, such as intraventricular hemorrhage, intracranial abscess, subdural hematomas, and intracerebral hemorrhage, with the aim to remove the hematic residues and enhance the functional recovery of the patients. IRRAflow® seems a promising and useful tool to treat infectious and hemorrhagic diseases in neuro-intensive care unit.
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Affiliation(s)
- Gloria Stati
- Anesthesia and Intensive Care School, University of Bologna, Resident, Bologna, Italy
| | - Ernesto Migliorino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Anesthesia and Intensive Care Unit, Bologna, Italy
| | - Manuel Moneti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Anesthesia and Intensive Care Unit, Bologna, Italy
| | - Carlo Alberto Castioni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Anesthesia and Intensive Care Unit, Bologna, Italy
| | - Antonino Scibilia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurosurgery Unit, Bologna, Italy
| | - Giorgio Palandri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurosurgery Unit, Bologna, Italy
| | - Giulio Virgili
- Department for Integrated Infectious Risk Management, AUSL of Bologna-S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Raffaele Aspide
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Anesthesia and Intensive Care Unit, Bologna, Italy.
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Hess RM, Khan A, Edwards M, Siddiqui AH, Levy EI. Continuous intraventricular vancomycin for treatment of ventriculitis using IRRAflow®: A case report. Surg Neurol Int 2022; 12:583. [PMID: 34992900 PMCID: PMC8720421 DOI: 10.25259/sni_1036_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/01/2021] [Indexed: 11/04/2022] Open
Abstract
Background Ventriculitis usually occurs as the result of infection and results in the inflammation of the ependymal lining of the ventricular system. Mortality rates remain high despite treatment. Case Description We present the case of a 66-year-old man who presented with altered mental status and progressively became comatose. He was found to have fulminant ventriculitis due to a ruptured intracranial abscess. He was treated with bilateral IRRAflow® catheter (IRRAS, Stockholm, Sweden) placement through which continuous irrigation with vancomycin was initiated. Conclusion This treatment was safe and led to improvement in the patient's neurologic examination, imaging findings, and cerebrospinal fluid profiles.
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Affiliation(s)
- Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo and Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo and Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Mallory Edwards
- Department of Neurocritical Care, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Adnan H Siddiqui
- Departments of Neurosurgery and Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo and Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Elad I Levy
- Departments of Neurosurgery and Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo and Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
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Hess RM, Lazar A, Smolar D, OConnor TE, Khan A, Siddiqui AH, Levy EI. Continuous Antibiotic Administration Using IRRAflow® Catheter for Treatment of Intracranial Abscess. Cureus 2021; 13:e19061. [PMID: 34853766 PMCID: PMC8608669 DOI: 10.7759/cureus.19061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
Intracranial abscesses are rare lesions with an incidence of approximately 4 per 1 million people. The optimal surgical management of these lesions is still unclear. We present the case of a patient who was discovered to have an intracranial abscess after presenting with right-sided weakness. He was treated via a combination of open craniotomy and continuous antibiotic irrigation using an IRRAflow® catheter (IRRAS, Stockholm, Sweden). Use of the IRRAflow® in this fashion has not yet been described in the literature. This novel approach appears to be safe and resulted in continued decrease in the abscess burden following surgical drainage.
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Affiliation(s)
- Ryan M Hess
- Neurosurgery, University at Buffalo Neurosurgery, Buffalo, USA
| | - Audrey Lazar
- Neurosurgery, Middlebury College, Middlebury, USA
| | - David Smolar
- Neurosurgery, Buffalo General Medical Center, Buffalo, USA
| | - Timothy E OConnor
- Neurosurgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Asham Khan
- Neurosurgery, University at Buffalo Neurosurgery, Buffalo, USA
| | | | - Elad I Levy
- Neurosurgery, University at Buffalo Neurosurgery, Buffalo, USA
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Davies J, Himstead AS, Kim JH, Chan AY, Tran DK, Hsu FP, Vadera S. Use of Automated Irrigating Drainage System in Six Patients With Chronic Subdural Hematoma: A Single-Center Experience. Cureus 2021; 13:e17355. [PMID: 34567895 PMCID: PMC8454598 DOI: 10.7759/cureus.17355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/08/2022] Open
Abstract
Background Chronic subdural hematoma (cSDH) is predicted to become the most common intracranial neurosurgical condition by 2030. Recurrence is estimated between 5-15%, and the use of a surgical drain is associated with lower recurrence rates. The authors present their experience with six patients undergoing cSDH evacuation with an irrigating drainage system, comprising the largest single-institution group in the United States (US). Methods IRB-approved, retrospective chart review was performed for six patients who underwent irrigating surgical drain placement during cSDH evacuation. Outcome measures included device settings and duration of the irrigating drain, postoperative length of stay, neurological status at follow-up, and hematoma recurrence. Results There were no recurrences noted within this group at last follow-up, with an average follow-up length over three months. The average postoperative length of stay was 2.67 ± 0.51 days. Patients were drained on average for 1.41 ± 0.49 days at 0cm water, irrigating at 55.25 ± 46.44cc/hr. On postoperative day one, average hematoma size and midline shift (MLS) reduction were respectively 13.43 ± 3.31mm and 5.71 ± 1.33mm. No device-related complications were noted. Conclusion The authors' early experience with this irrigating drainage device demonstrates that it is safe and effective for this population. Although this is a preliminary study on a small sample size, the excellent results warrant further investigation and establishment of a standard protocol to compare against current treatment regimens.
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Affiliation(s)
- Jordan Davies
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Alexander S Himstead
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Ji Hyun Kim
- Department of Neuroscience, Johns Hopkins University, Baltimore, USA
| | - Alvin Y Chan
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Diem Kieu Tran
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Frank P Hsu
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Sumeet Vadera
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
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Rajjoub K, Hess RM, O'Connor TE, Khan A, Siddiqui AH, Levy EI. Drainage, Irrigation, and Fibrinolytic Therapy (DRIFT) for Adult Intraventricular Hemorrhage Using IRRAflow® Self-Irrigating Catheter. Cureus 2021; 13:e15167. [PMID: 34168930 PMCID: PMC8216022 DOI: 10.7759/cureus.15167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 01/21/2023] Open
Abstract
Intraventricular hemorrhage (IVH) is a devastating neurosurgical condition associated with high rates of morbidity and mortality. It can occur as the result of several pathologies and typically presents with mental status changes, neurologic deficits, seizures, headaches, and decreased Glasgow Coma Scale score. These patients are often treated with placement of an external ventricular drain, which helps decrease the clot burden; however, they commonly clot off leading to multiple exchanges. We present a case in which drainage, irrigation, and fibrinolytic (DRIFT) therapy using IRRAflow® (IRRAS) irrigating catheter was used to treat a patient with severe IVH secondary to aneurysmal subarachnoid hemorrhage.
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Affiliation(s)
- Kenan Rajjoub
- Neurosurgery, University at Buffalo Neurosurgery, Buffalo, USA
| | - Ryan M Hess
- Neurosurgery, University at Buffalo Neurosurgery, Buffalo, USA
| | | | - Asham Khan
- Neurosurgery, University at Buffalo Neurosurgery, Buffalo, USA
| | - Adnan H Siddiqui
- Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA
| | - Elad I Levy
- Neurosurgery, University at Buffalo Neurosurgery, Buffalo, USA
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