Endoscopic lavage of the cerebral ventricular system for ventriculitis treatment in a patient with complicated new coronavirus infection (COVID‑19)

Abstract

Introduction. The new coronavirus infection (COVID‑19) has a wide spectrum of complications. Frequency of neurological symptoms varies between 17.3 and 36.4 %. In 8 % of cases, COVID‑19 can be accompanied by bacterial or fungal infection. Since few descriptions of bacterial meningitis in adult patients with COVID‑19 and a single description of surgical treatment of purulent meningitis complicated by empyema of the 4th ventricle in a patient with COVID‑19 were found, and there are no meta‑analyses in this area, descriptions of such cases are of high scientific and practical value.Aim. The describe a case of surgical treatment of purulent ventriculitis in an adult (during treatment of the new coronavirus infection COVID‑19).Materials and methods. A man, 69 years old, with previously established diagnosis of the new coronavirus infection COVID‑19 and a comorbid pathology was admitted to the Moscow City Clinical Hospital No. 40 with newly diagnosed seizure disorder. Computed tomography imaging showed ventriculitis confirmed by MRI with obstructive hypertensive triventricular hydrocephalus.Results. The patient underwent treatment: three‑time endoscopic lavage of the ventricular system, removal of newly formed fibrin membranes with interventricular septostomy, removal of obstruction at the level of the Sylvian aqueduct; the surgery was concluded by external draining of the lateral ventricles, administration of an antibiotic intro the ventricular system and intravenously. Cerebrospinal fluid flow was restored, ventriculitis manifestations completely negated.Conclusion. Development of ventriculitis as one of the first signs of bacterial infection accompanying COVID‑19 is a very rare and life‑threatening complication requiring active surgical intervention. In was shown that endoscopic lavage of the ventricular system for ventriculitis treatment is an effective action against infection and cerebrospinal fluid flow disorders. Use of intraventricular endoscopy for ventriculitis treatment has several advantages compared to needle ventriculostomy. Further studies and analysis of treatment of bacterial ventriculitis using endoscopic surgical techniques in patients with and without the new coronavirus infection are needed.