Use of bilateral occipital horn ventricular lavage in treating adults with CSF drain-associated acute pyogenic ventriculitis.

OBJECTIVE

The aim of this study was to describe a bilateral occipital horn approach for ventricular lavage in treating acute pyogenic ventriculitis (APV) associated with CSF drainage and compare its efficacy with the conventional unilateral frontal horn approach.

METHODS

The authors conducted a retrospective comparative study in 85 patients with APV due to CSF drainage treated by intraventricular lavage. Patients were divided into a bilateral occipital horn (bi-occipital) group (n = 41) and a unilateral frontal horn (uni-frontal) group (n = 44) based on the surgical approach used (bilateral occipital horn vs unilateral frontal horn). Primary outcomes included CSF microbiological/cytological normalization, imaging-based clearance of ventricular pus, procedure-related complications, mortality, and 90-day modified Rankin Scale (mRS) score, and these outcomes were compared between cohorts.

RESULTS

The bi-occipital group required shorter external ventricular drainage (EVD) duration (median 22 [interquartile range (IQR) 19-29] vs 29 [IQR 25-34] days, p = 0.008), fewer external ventricular drain revisions (median 5 [IQR 4-7] vs 8 [IQR 6-10] revisions, p < 0.001), and reduced intraventricular antibiotic days (median 10 [IQR 9-12] vs 14 [IQR 11-17] days, p < 0.001). Kaplan-Meier analysis demonstrated that bi-occipital lavage significantly accelerated CSF sterilization, white blood cell normalization, and intraventricular pus clearance. The bi-occipital group showed a markedly lower incidence of complex hydrocephalus (6.7% vs 27.0%, p = 0.031) than the uni-frontal group. The mortality rate in the bi-occipital group was 7.3% (3/41), which was lower than that in the uni-frontal group (15.9%, 7/44), but this difference was not statistically significant (p = 0.219). The bi-occipital group showed a greater improvement in mRS score between day 30 and day 90 (mean ΔmRS score -0.61 [SD 0.64]) compared to the uni-frontal group (mean ΔmRS score -0.25 [SD 0.44]), with a statistically significant between-group difference (p = 0.004). On day 90, the bi-occipital group demonstrated a significantly lower proportion of patients with poor outcomes than the uni-frontal group (17.1% vs 38.6%, p = 0.032).

CONCLUSIONS

The bilateral occipital horn lavage technique demonstrated superior clinical efficacy to unilateral frontal horn lavage in APV management, as evidenced by accelerated infection control and improved neurological recovery. This technically feasible approach provided an effective alternative in resource-limited settings.