Abstract Ref Number = APCP1103
Infected VP Shunt Followed with Intraventricular Empyema
Nico Adi Saputra,Steven Tandean,Andry Juliansen,Julius July
Siloam Hospitals and Medical Faculty of UPH University Tangerang Indonesia Department of Neurosurgery Siloam Hospitals and Medical Faculty of Universitas Sumatera Utara, Medan, Indonesia Department of Paediatric Siloam Hospitals and Medical Faculty of UPH University, Tangerang, Indonesia Department of Neurosurgery Siloam Hospitals and Medical Faculty of UPH University, Tangerang, Indonesia
Background : One of the most common and serious complications of ventriculoperitoneal (VP) shunt is infection. Although the shunt infection is high but management of shunt infection is still a challenge, with shunt infection management protocols are varying significantly between centers. Cases with Intraventricular Empyema are even more challenging and complex. We report a case with effective aggressive treatment of Intraventricular Empyema, consist of active irrigation and aspiration of pus and followed with intraventricular antibiotic.
Case Presentation Summary : A boy born with lumbosacral myelomeningocele who then ruptured when he was 7 days old and taken by his parents to the nearest hospital which then performed surgery. Five days after the surgery, he developed hydrocephalus that require VP Shunt. Six weeks after VP Shunt, he was diagnosed with shunt infection and MRI showed Intraventricular Empyema. To improve patient’s condition, removal of the shunt and extensive ventricular irrigation using warm normal saline and active suction of the pus was performed via neuroendoscopy that has two separate channels to be used simultaneously, one channel for normal saline irrigation and other channel for continuous suction using nasogastric tube 8 Fr. The procedure was started from right ventricle then to the left through septostomy. External Ventricular Drain (EVD) was left for evaluation and administration of intraventricular antibiotic. After 6 day the imaging showed no restriction on DWI and the ventricle size has no further dilatation. He was fine and sent home without shunt. Repeated MRI at 3 month indicate that he need permanent shunt, and the shunt was done with no further infection.
Learning Points/Discussion : Effective aggressive irrigation and suction of pus with intraventricular antibiotics can be one of the options for treating intraventricular empyema.
Keywords: Intraventricular Empyema Infected VP Shunt Neuroendoscopy Intraventricular Antibiotic