{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:01:47Z","timestamp":1780131707861,"version":"3.54.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The aim of this study was to describe a bilateral occipital horn approach for ventricular lavage in treating acute pyogenic ventriculitis (APV) associated with CSF drainage and compare its efficacy with the conventional unilateral frontal horn approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a retrospective comparative study in 85 patients with APV due to CSF drainage treated by intraventricular lavage. Patients were divided into a bilateral occipital horn (bi-occipital) group (n = 41) and a unilateral frontal horn (uni-frontal) group (n = 44) based on the surgical approach used (bilateral occipital horn vs unilateral frontal horn). Primary outcomes included CSF microbiological\/cytological normalization, imaging-based clearance of ventricular pus, procedure-related complications, mortality, and 90-day modified Rankin Scale (mRS) score, and these outcomes were compared between cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The bi-occipital group required shorter external ventricular drainage (EVD) duration (median 22 [interquartile range (IQR) 19\u201329] vs 29 [IQR 25\u201334] days, p = 0.008), fewer external ventricular drain revisions (median 5 [IQR 4\u20137] vs 8 [IQR 6\u201310] revisions, p &lt; 0.001), and reduced intraventricular antibiotic days (median 10 [IQR 9\u201312] vs 14 [IQR 11\u201317] days, p &lt; 0.001). Kaplan-Meier analysis demonstrated that bi-occipital lavage significantly accelerated CSF sterilization, white blood cell normalization, and intraventricular pus clearance. The bi-occipital group showed a markedly lower incidence of complex hydrocephalus (6.7% vs 27.0%, p = 0.031) than the uni-frontal group. The mortality rate in the bi-occipital group was 7.3% (3\/41), which was lower than that in the uni-frontal group (15.9%, 7\/44), but this difference was not statistically significant (p = 0.219). The bi-occipital group showed a greater improvement in mRS score between day 30 and day 90 (mean \u0394mRS score \u22120.61 [SD 0.64]) compared to the uni-frontal group (mean \u0394mRS score \u22120.25 [SD 0.44]), with a statistically significant between-group difference (p = 0.004). On day 90, the bi-occipital group demonstrated a significantly lower proportion of patients with poor outcomes than the uni-frontal group (17.1% vs 38.6%, p = 0.032).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The bilateral occipital horn lavage technique demonstrated superior clinical efficacy to unilateral frontal horn lavage in APV management, as evidenced by accelerated infection control and improved neurological recovery. This technically feasible approach provided an effective alternative in resource-limited settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.focus25625","type":"journal-article","created":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T12:05:39Z","timestamp":1761998739000},"page":"E13","source":"Crossref","is-referenced-by-count":0,"title":["Use of bilateral occipital horn ventricular lavage in treating adults with CSF drain\u2013associated acute pyogenic ventriculitis"],"prefix":"10.3171","volume":"59","author":[{"given":"Tao","family":"Zeng","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Ni","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zijun","family":"Xu","sequence":"additional","affiliation":[{"name":"Radiology, Shanghai Tenth People\u2019s Hospital, Shanghai, People\u2019s Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming Sheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Gao","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Hosp Infect","first-page":"281","article-title":"Surveillance and management of ventriculitis following neurosurgery","volume":"89","author":"Humphreys H","year":"2015","unstructured":"Humphreys H, Jenks P. Surveillance and management of ventriculitis following neurosurgery. J Hosp Infect. 2015;89(4):281\u2013286."},{"issue":"4","key":"b2","series-title":"J Infect Chemother","first-page":"534","article-title":"Fulminant ependymitis following intraventricular rupture of brain abscess","volume":"17","author":"Inamasu J","year":"2011","unstructured":"Inamasu J, Kuramae T, Tomiyasu K, Nakatsukasa M. Fulminant ependymitis following intraventricular rupture of brain abscess. J Infect Chemother. 2011;17(4):534\u2013537."},{"issue":"12","key":"b3","series-title":"Lancet Infect Dis","first-page":"751","article-title":"Current control and treatment of multidrug-resistant Acinetobacter baumannii infections","volume":"8","author":"Karageorgopoulos DE","year":"2008","unstructured":"Karageorgopoulos DE, Falagas ME. Current control and treatment of multidrug-resistant Acinetobacter baumannii infections. Lancet Infect Dis. 2008;8(12):751\u2013762."},{"issue":"3","key":"b4","series-title":"Neurocrit Care","first-page":"609","article-title":"Current practices of intraventricular antibiotic therapy in the treatment of meningitis and ventriculitis: results from a multicenter retrospective cohort study","volume":"30","author":"Lewin JJ","year":"2019","unstructured":"Lewin JJ, Cook AM, Gonzales C,  Current practices of intraventricular antibiotic therapy in the treatment of meningitis and ventriculitis: results from a multicenter retrospective cohort study. Neurocrit Care. 2019;30(3):609\u2013616."},{"issue":"6","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"682","article-title":"Outcome improvement in cerebral ventriculitis after ventricular irrigation: a prospective controlled study","volume":"26","author":"Al Menabbawy A","year":"2020","unstructured":"Al Menabbawy A, El Refaee E, Soliman MAR,  Outcome improvement in cerebral ventriculitis after ventricular irrigation: a prospective controlled study. J Neurosurg Pediatr. 2020;26(6):682\u2013690."},{"key":"b6","series-title":"Front Neurol","first-page":"1174","article-title":"Outcome following the treatment of ventriculitis caused by multi\/extensive drug resistance gram negative bacilli; Acinetobacter baumannii and Klebsiella pneumonia","volume":"9","author":"Pandey S","year":"2018","unstructured":"Pandey S, Li L, Deng XY, Cui DM, Gao L. Outcome following the treatment of ventriculitis caused by multi\/extensive drug resistance gram negative bacilli; Acinetobacter baumannii and Klebsiella pneumonia. Front Neurol. 2018;9:1174."},{"issue":"5","key":"b7","series-title":"Oper Neurosurg","first-page":"E142","article-title":"Commentary: side-to-side superficial temporal artery to middle cerebral artery bypass technique: application of fourth generation bypass in a case of adult moyamoya disease","volume":"18","author":"Chagoya G","year":"2020","unstructured":"Chagoya G, Harrigan MR. Commentary: side-to-side superficial temporal artery to middle cerebral artery bypass technique: application of fourth generation bypass in a case of adult moyamoya disease. 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Front Surg. 2022;9:854627."},{"issue":"4","key":"b17","series-title":"Cureus","first-page":"e1175","article-title":"Bilateral external ventricular drain placement and intraventricular irrigation combined with concomitant serial prone patient positioning: a novel treatment for gravity-dependent layering in bacterial ventriculitis","volume":"9","author":"Chan AK","year":"2017","unstructured":"Chan AK, Birk HS, Yue JK, Winkler EA, Mcdermott MW. Bilateral external ventricular drain placement and intraventricular irrigation combined with concomitant serial prone patient positioning: a novel treatment for gravity-dependent layering in bacterial ventriculitis. 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Clin Neurol Neurosurg. 2016;146:147\u2013151."},{"key":"b23","series-title":"World Neurosurg","first-page":"315","article-title":"The role of endoscopic lavage in recalcitrant multidrug-resistant gram-negative ventriculitis among neurosurgical patients","volume":"93","author":"Kumar A","year":"2016","unstructured":"Kumar A, Agrawal D, Sharma BS. The role of endoscopic lavage in recalcitrant multidrug-resistant gram-negative ventriculitis among neurosurgical patients. World Neurosurg. 2016;93:315\u2013323."},{"issue":"4","key":"b1","series-title":"J Hosp Infect","first-page":"281","article-title":"Surveillance and management of ventriculitis following neurosurgery","volume":"89","author":"Humphreys H","year":"2015","unstructured":"Humphreys H, Jenks P. Surveillance and management of ventriculitis following neurosurgery. J Hosp Infect. 2015;89(4):281\u2013286."},{"issue":"4","key":"b2","series-title":"J Infect Chemother","first-page":"534","article-title":"Fulminant ependymitis following intraventricular rupture of brain abscess","volume":"17","author":"Inamasu J","year":"2011","unstructured":"Inamasu J, Kuramae T, Tomiyasu K, Nakatsukasa M. Fulminant ependymitis following intraventricular rupture of brain abscess. J Infect Chemother. 2011;17(4):534\u2013537."},{"issue":"12","key":"b3","series-title":"Lancet Infect Dis","first-page":"751","article-title":"Current control and treatment of multidrug-resistant Acinetobacter baumannii infections","volume":"8","author":"Karageorgopoulos DE","year":"2008","unstructured":"Karageorgopoulos DE, Falagas ME. Current control and treatment of multidrug-resistant Acinetobacter baumannii infections. Lancet Infect Dis. 2008;8(12):751\u2013762."},{"issue":"3","key":"b4","series-title":"Neurocrit Care","first-page":"609","article-title":"Current practices of intraventricular antibiotic therapy in the treatment of meningitis and ventriculitis: results from a multicenter retrospective cohort study","volume":"30","author":"Lewin JJ","year":"2019","unstructured":"Lewin JJ, Cook AM, Gonzales C,  Current practices of intraventricular antibiotic therapy in the treatment of meningitis and ventriculitis: results from a multicenter retrospective cohort study. Neurocrit Care. 2019;30(3):609\u2013616."},{"issue":"6","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"682","article-title":"Outcome improvement in cerebral ventriculitis after ventricular irrigation: a prospective controlled study","volume":"26","author":"Al Menabbawy A","year":"2020","unstructured":"Al Menabbawy A, El Refaee E, Soliman MAR,  Outcome improvement in cerebral ventriculitis after ventricular irrigation: a prospective controlled study. J Neurosurg Pediatr. 2020;26(6):682\u2013690."},{"key":"b6","series-title":"Front Neurol","first-page":"1174","article-title":"Outcome following the treatment of ventriculitis caused by multi\/extensive drug resistance gram negative bacilli; Acinetobacter baumannii and Klebsiella pneumonia","volume":"9","author":"Pandey S","year":"2018","unstructured":"Pandey S, Li L, Deng XY, Cui DM, Gao L. Outcome following the treatment of ventriculitis caused by multi\/extensive drug resistance gram negative bacilli; Acinetobacter baumannii and Klebsiella pneumonia. Front Neurol. 2018;9:1174."},{"issue":"5","key":"b7","series-title":"Oper Neurosurg","first-page":"E142","article-title":"Commentary: side-to-side superficial temporal artery to middle cerebral artery bypass technique: application of fourth generation bypass in a case of adult moyamoya disease","volume":"18","author":"Chagoya G","year":"2020","unstructured":"Chagoya G, Harrigan MR. Commentary: side-to-side superficial temporal artery to middle cerebral artery bypass technique: application of fourth generation bypass in a case of adult moyamoya disease. Oper Neurosurg. 2020;18(5):E142\u2013E469."},{"issue":"6","key":"b8","series-title":"Clin Infect Dis","first-page":"e34","article-title":"2017 Infectious Diseases Society of America\u2019s clinical practice guidelines for healthcare-associated ventriculitis and meningitis","volume":"64","author":"Tunkel AR","year":"2017","unstructured":"Tunkel AR, Hasbun R, Bhimraj A,  2017 Infectious Diseases Society of America\u2019s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. 2017;64(6):e34\u2013e65."},{"issue":"2","key":"b9","series-title":"Infect Dis Clin Pract (Baltim Md)","first-page":"100","article-title":"Current concepts and approach to ventriculitis","volume":"16","author":"Agrawal A","year":"2008","unstructured":"Agrawal A, Cincu R, Timothy J. Current concepts and approach to ventriculitis. 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Infect Drug Resist. 2019;12:241\u2013247."},{"key":"b16","series-title":"Front Surg","first-page":"854627","article-title":"Clinical characteristics of hydrocephalus following the treatment of pyogenic ventriculitis caused by multi\/extensive drug-resistant gram-negative bacilli, Acinetobacter baumannii, and Klebsiella pneumoniae","volume":"9","author":"Pandey S","year":"2022","unstructured":"Pandey S, Yao PW, Qian Z, Ji T, Wang K, Gao L. Clinical characteristics of hydrocephalus following the treatment of pyogenic ventriculitis caused by multi\/extensive drug-resistant gram-negative bacilli, Acinetobacter baumannii, and Klebsiella pneumoniae. Front Surg. 2022;9:854627."},{"issue":"4","key":"b17","series-title":"Cureus","first-page":"e1175","article-title":"Bilateral external ventricular drain placement and intraventricular irrigation combined with concomitant serial prone patient positioning: a novel treatment for gravity-dependent layering in bacterial ventriculitis","volume":"9","author":"Chan AK","year":"2017","unstructured":"Chan AK, Birk HS, Yue JK, Winkler EA, Mcdermott MW. Bilateral external ventricular drain placement and intraventricular irrigation combined with concomitant serial prone patient positioning: a novel treatment for gravity-dependent layering in bacterial ventriculitis. 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