Ventricular lavage (VeLa) for ventriculitis: A systematic review of techniques and meta-analysis of outcomes.
4 affiliations
- 1Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines.
- 2Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines.
- 3Division of Pediatric Neurology, Department of Pediatrics, University of the Philippines - Philippine General Hospital, Manila, Philippines.
- 4Division of Infectious Diseases, Department of Medicine, University of the Philippines - Philippine General Hospital, Manila, Philippines.
Abstract
Introduction
Ventriculitis is a severe complication of cerebrospinal fluid (CSF) diversion procedures associated with high morbidity and mortality despite advances in antimicrobial therapy. Ventricular lavage (VeLa) has emerged as a potential adjunctive intervention to improve infection clearance and neurological outcomes.Research question
This study aimed to systematically review the surgical techniques of VeLa and evaluate its effectiveness in the treatment of ventriculitis compared with conventional therapy alone.Methods
A systematic review and meta-analysis were conducted according to PRISMA guidelines. Electronic databases were searched from inception to August 2025. Studies describing VeLa for ventriculitis were included. Data on surgical techniques, perioperative variables, complications, and clinical outcomes were extracted. Quantitative synthesis was performed using a random-effects model in RevMan.Results
Twenty-seven studies were included in the qualitative synthesis and five in the meta-analysis, comprising one randomized controlled trial and four cohort studies. Common techniques involved ventricular access through Kocher's point, endoscope-assisted septostomy, high-volume irrigation until clear effluent, and antibiotic-enriched lavage solutions. Compared with conventional therapy alone, VeLa was associated with lower mortality and improved functional outcomes, including higher odds of achieving a modified Rankin Scale score <3. VeLa also significantly reduced in-hospital parameters including drain duration, hospital stay, and duration of intravenous antibiotic therapy. Reported complications were infrequent and generally manageable.Discussion and conclusion
VeLa may be associated with improved survival and functional recovery, as well as shorter hospitalization and antibiotic duration, when used as an adjunct to conventional treatment for ventriculitis. However, the limited and predominantly observational evidence, together with methodological heterogeneity, precludes definitive conclusions. These findings should be considered hypothesis-generating and warrant validation through larger, well-designed multicenter prospective studies using standardized treatment protocols.
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BibTeX
@article{cayanong2026ventricular,
title = {{Ventricular lavage (VeLa) for ventriculitis: A systematic review of techniques and meta-analysis of outcomes.}},
author = {Edmund John B Cayanong and Natalie Roxanne B Nisce and Renarose Angela J Cadiz and Beatricia Alyssandra L Luceno and Jonnel B Poblete and Ronnie E Baticulon},
journal = {Brain \& spine},
year = {2026},
month = oct,
doi = {10.1016/j.bas.2026.107490},
url = {https://europepmc.org/article/MED/42960157},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Ventricular lavage (VeLa) for ventriculitis: A systematic review of techniques and meta-analysis of outcomes.
AU - Edmund John B Cayanong
AU - Natalie Roxanne B Nisce
AU - Renarose Angela J Cadiz
AU - Beatricia Alyssandra L Luceno
AU - Jonnel B Poblete
AU - Ronnie E Baticulon
PY - 2026
DA - 2026/10/23
JO - Brain & spine
DO - 10.1016/j.bas.2026.107490
UR - https://europepmc.org/article/MED/42960157
AB - Introduction Ventriculitis is a severe complication of cerebrospinal fluid (CSF) diversion procedures associated with high morbidity and mortality despite advances in antimicrobial therapy. Ventricular lavage (VeLa) has emerged as a potential adjunctive intervention to improve infection clearance and neurological outcomes.Research question This study aimed to systematically review the surgical techniques of VeLa and evaluate its effectiveness in the treatment of ventriculitis compared with conventional therapy alone.Methods A systematic review and meta-analysis were conducted according to PRISMA guidelines. Electronic databases were searched from inception to August 2025. Studies describing VeLa for ventriculitis were included. Data on surgical techniques, perioperative variables, complications, and clinical outcomes were extracted. Quantitative synthesis was performed using a random-effects model in RevMan.Results Twenty-seven studies were included in the qualitative synthesis and five in the meta-analysis, comprising one randomized controlled trial and four cohort studies. Common techniques involved ventricular access through Kocher's point, endoscope-assisted septostomy, high-volume irrigation until clear effluent, and antibiotic-enriched lavage solutions. Compared with conventional therapy alone, VeLa was associated with lower mortality and improved functional outcomes, including higher odds of achieving a modified Rankin Scale score <3. VeLa also significantly reduced in-hospital parameters including drain duration, hospital stay, and duration of intravenous antibiotic therapy. Reported complications were infrequent and generally manageable.Discussion and conclusion VeLa may be associated with improved survival and functional recovery, as well as shorter hospitalization and antibiotic duration, when used as an adjunct to conventional treatment for ventriculitis. However, the limited and predominantly observational evidence, together with methodological heterogeneity, precludes definitive conclusions. These findings should be considered hypothesis-generating and warrant validation through larger, well-designed multicenter prospective studies using standardized treatment protocols.
SN - 2772-5294
ER -