Antibiotic impregnated external ventricular drainage and third ventriculostomy in the management of hydrocephalus associated with posterior cranial fossa tumours.
BACKGROUND
The effectiveness of antibiotic pre-treated ventricular catheters in reducing the risk of CSF infections (determined on CSF cultures) resulting from the use of per-operative external ventricular drainages (EVD) and the success rate of post-operative endoscopic third ventriculostomy (ETV) in the management of persistent hydrocephalus after posterior cranial fossa tumour removal are assessed.


METHODS
Forty-seven children (group I) were prospectively managed by means of per-operative antibiotic impregnated EVD, post-operative ICP monitoring, and ETV. The results of this group were compared with those of a control group composed by 44 children treated with the same protocol as above except for the use of not-impregnated catheters (group II).


RESULTS
The rate of positive CSF cultures due to EVD resulted significantly lower in group I (2.1% vs 31.8%); there was no clinical evidence of CSF infections. The success rate of ETV was the same in both groups (75%). Failures of ETV occurred in the patients with subarachnoid tumour seeding and/or tumour extension to the basal cisterns. All the children of group II with failed ETV also showed a bacterial growth in the CSF.


CONCLUSIONS
Antibiotic pre-treated catheters in our experience considerably limited EVD-related bacterial growth in the CSF. Preoperative hydrocephalus resolved in 60% of the cases after tumour removal, thus confirming recent data from the literature against the routine use of preoperative ETV. In our experience postoperative ETV had a high success rate; poor results were obtained in children with tumour seeding and/or the evidence of positive CSF cultures.
Tamburrini
Gianpiero
G
Paediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Largo A. Gemelli, 8, 00168 Rome, Italy. gianpiero.tamburrini@rm.unicatt.it
Massimi
Luca
L
Caldarelli
Massimo
M
Di Rocco
Concezio
C
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology / Q000592:standards; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D020546:Fourth Ventricle / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D015192:Infratentorial Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D009366:Neoplasm Seeding; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000517:prevention & control; D020542:Third Ventricle / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000295:instrumentation* / Q000379:methods; D014696:Ventriculostomy / Q000379:methods* / Q000706:statistics & numerical data
D000900:Anti-Bacterial Agents