Treatment of Postmeningitic Hydrocephalus

Summary

Even with the advent of antibiotics, treatment of postmeningitic hydrocephalus has been a difficult problem. Early surgical intervention based on new diagnostic modalities has improved mortality and morbidity. We reviewed 43 cases of postmeningitic hydrocephalus treated at our Institute over the past 20 years so that we could determine an effective therapeutic regimen. The subjects were 43 patients who had hydrocephalus following purulent meningitis. The results of our review were: 1. Thirty cases occurred during the first 10 years, while 13 occurred during the last 10 years, indicating a decline in the number of cases. 2. Meningitis was due to delayed treatment for myelomeningocele in 5 cases or encephalocele (1 case) 3. Complications such as brain abscess (4 cases) and subdural abscess (2 cases) or effusion (3 cases) were factors for poor prognoses. 4. Twenty five percent of the patients had multiloculated ventricular systems, resulting in a grave outcome. 5. Shunt operations should be postponed until ventricular fluid improves in accordance with these parameters: protein, less than 300 mg/dl, preferably less than 100 mg/dl; glucose, more than 30 mg/dl; cell counts, less than 200/3 cells per mm³. 6) Prognoses for the first 30 patients were poor, while those for the last 13 were improved. The present review indicates that early diagnosis and early treatment of meningitis are the keys to promising prognosis. Close communication with pediatricians is most important.