Abstract
Ventriculitis may complicate neurosurgical procedures, for example, due to shunt or
external ventricular drainage infection. Clearance of the infection with subsequent
intravenous antibiotic therapy and shunt reinsertion, if necessary, are the standard
treatment procedures with a high rate of success. Here, we report on a protracted
complication, the development of destructive subependymal cysts, illustrate its treatment
and discuss the pathomechanisms. The 2-year-and-9-month-old girl was admitted 5 weeks
after a shunt revision with symptoms of shunt infection. Ventriculitis caused by Streptococcus salivarius (S. salivarius) was diagnosed and intravenous antibiotic treatment was performed. A new shunt system
was implanted after clearance of infection and the girl did not show clinical signs
of infection thereafter. A routine follow-up magnetic resonance imaging (MRI) revealed
progressive and space-occupying multifocal subependymal cysts with partial destruction
of the corpus callosum including compression of the ventricular system. Endoscopic
broad-based laser fenestration of all cysts resulted in sustained regression of cavity
formation. The cognitive development of the girl assessed 2 years afterward was completely
normal. We conclude that routine follow-up MRI investigations are recommended 6 months
after successful treatment of ventriculitis to detect protracted postinflammatory
destructive subependymal cyst formations. Endoscopic broad-based laser–assisted cyst
fenestration can stop progression and lead to regression of postinfectious subependymal
cysts.
Keywords
ventriculitis - destructive subependymal cysts - endoscopic laser fenestration
