Destructive Subependymal Cysts following Ventriculitis–Pathomechanisms and Treatment

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

• References

• 1 Barkovich AJ. Pediatric Neuroimaging. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000
• 2 Quinn JV, Steele RW. Ventriculitis following a neurosurgic procedure. Clin Pediatr (Phila) 2002; 41 (6) 439-441
• 3 Conangla G, Rodríguez L, Alonso-Tarrés C, Avila A, de la Campa AG. [Streptococcus salivarius meningitis after spinal anesthesia]. Neurologia 2004; 19 (6) 331-333
• 4 Conte A, Chinello P, Civljak R, Bellussi A, Noto P, Petrosillo N. Streptococcus salivarius meningitis and sphenoid sinus mucocele. Case report and literature review. J Infect 2006; 52 (1) e27-e30
• 5 Wilson M, Martin R, Walk ST , et al. Clinical and laboratory features of Streptococcus salivarius meningitis: a case report and literature review. Clin Med Res 2012; 10 (1) 15-25
• 6 Barkovich AJ. Ventriculitis. In: A. James Barkovich, Kevin R. Moore, Elena Grant, Blaise V. Jones, eds. Diagnostic Imaging: Pediatric Neuroradiology. 1st ed. Salt Lake City, UT: Amirsys-Elsevier; 2007: 34-35
• 7 Berman PH, Banker BQ. Neonatal meningitis. A clinical and pathological study of 29 cases. Pediatrics 1966; 38 (1) 6-24
• 8 Volpe JJ. Neurology of the Newborn. 5th ed. Philadelphia, PA: WB Saunders; 2008
• 9 Naidich TP, McLone DG, Yamanouchi Y. Periventricular white-matter cysts in a murine model of gram-negative ventriculitis. AJNR Am J Neuroradiol 1983; 4 (3) 461-465
• 10 McLone DG, Killion M, Yogev R, Sommers MW. Ventriculitis of mice and men. In: American Society for Pediatric Neurosurgery, ed. Concepts in Pediatric Neurosurgery. Vol. 2. Basel: Karger; 1982: 112-126
• 11 Ebner FH, Nagel C, Tatagiba M, Schuhmann MU. Efficacy and versatility of the 2-micron continuous wave laser in neuroendoscopic procedures. Acta Neurochir Suppl (Wien) 2012; 113 (Suppl 113): 143-147