Intraventricular and lumbar intrathecal administration of antibiotics in postneurosurgical patients with meningitis and/or ventriculitis in a serious clinical state.

OBJECT: To date, reports on the clinical efficacy of intraventricularly and intrathecally administered antibiotics for the treatment of neurosurgical ventriculitis and meningitis in adults are limited. The authors aimed to evaluate the efficacy and safety of the intraventricular (IVT) and lumbar intrathecal (IT) administration of antibiotics in critically ill neurosurgical patients. METHODS: Thirty-four postneurosurgical patients with meningitis and ventriculitis were studied. Intraventricular/lumbar intrathecal antibiotics were administered due to positive CSF cultures persisting despite the use of intravenous antibiotics. The time period until CSF sterilization, changes in clinical state, and efficacy of different routes of antibiotic administration were evaluated. RESULTS: The mean time necessary to obtain CSF sterilization was 2.9 ± 2.7 days (range 1-12 days). The CSF cultures became negative within 24 hours after the administration of IVT/IT antibiotics in 17 patients (50%) and up to 48 hours in a further 6 patients (18%). The clinical outcome of patients assessed by the modified Rankin Scale improved in 17 patients (50%), stayed unchanged in 10 patients (29%), and was impaired in 1 patient (3%). Six patients (18%) died; however, 2 of them died due to reasons not directly related to meningitis or ventriculitis, so the overall mortality rate for meningitis and/or ventriculitis was 11.8% in this group of patients. All patients with ventriculitis (n = 4) were treated by antibiotics administered via the IVT route. The average time to CSF sterilization was 6.5 days in the patients with ventriculitis. Thirty patients had clinical signs of meningitis without ventriculitis. Despite the higher ratio of unfavorable Gram-negative meningitis in the subgroup of patients treated via lumbar drainage, the mean duration of CSF sterilization was 2.2 days compared with 2.6 days in the subgroup treated via external ventricular drainage, a difference that was not statistically significant (p = 0.3). Adverse effects of IVT/IT antibiotics appeared in 3 of 34 patients and were of low clinical significance. CONCLUSIONS: Intraventricular/lumbar intrathecal antibiotics can lead to very quick CSF sterilization in postneurosurgical patients with meningitis and ventriculitis. The relapse rate of meningitis and/or ventriculitis is also very low among patients treated by IVT/IT antibiotics. Intraventricular/lumbar intrathecal administration of antibiotics appears to be an effective and safe treatment for infections of the CNS caused by multidrug-resistant organisms. In patients with signs of ventriculitis, the authors prefer the IVT route of antibiotics. This study did not prove a lower efficacy of administration of antibiotics via lumbar drainage compared with the ventricular route in patients with meningitis.

[The use of modern microneurosurgical methods and state of the art technologies in the treatment of brain tumors and neurovascular diseases]. / Aplikace moderní mikroneurochirurgie a soucasných technologií pri resení nádorových a cévních onemocnení mozku.

Brain tumors and neurovascular diseases represent the most frequent and serious areas of intracranial neurosurgery. The recent advances in microneurosurgery aim at the complete treatment of the lesions (i.e. radical removal of the tumor, total occlusion of the vascular malformation) while respecting the minimal invasivity for the patient and avoiding risks and morbidity of the surgical procedure. The main tools used in order to accomplish this end are partly meticulous application of recent microneurosurgical principles that enable to treat complicated and deep lesions with minimal retraction and risk of injury to nerves and vascular structures, partly the use of contemporary technologies. Neuronavigation and functional neuronavigation facilitate exact preoperative planning and intraoperative orientation, methods based on fluorescence help to display intravascular blood flow or residual tumor in the operative field and intraoperative magnetic resonance allows exact morphological imaging of the intracranial structures during surgical procedure and increases accuracy of navigation. Electrophysiological monitoring helps to increase the safety of the procedure by continuous tracking of selected brain and nerve functions. Tailored combination and cooperation of aforementioned methods maximizes effect for the uneventful outcome. We present review paper on application of these methods and our experiences in the neurosurgical department Na Homolce hospital and show illustrative cases.