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CASE REPORT
Use of ventriculostomy in the treatment of septic cavernous sinus thrombosis (SCST)
  1. Justin Thomas1,
  2. Mohamad Fayad2,
  3. Doris Tong1 and
  4. Boyd F Richards1
  1. 1 Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, Michigan, USA
  2. 2 Neurology, Ascension Macomb-Oakland Hospital, Madison Heights, Michigan, USA
  1. Correspondence to Dr Justin Thomas, docjt87{at}gmail.com

Abstract

We present a novel treatment with the use of intraventricular antibiotics delivered through a ventriculostomy in a patient who developed septic cavernous sinus thrombosis after sinus surgery. A 65-year-old woman presented with acute on chronic sinusitis. The patient underwent a diagnostic left maxillary antrostomy, ethmoidectomy, sphenoidotomy and sinusotomy. Postoperatively, the patient experienced altered mental status with episodic fever despite treatment with broad-spectrum antimicrobial therapy. MRI of the brain showed extensive meningeal enhancement with the involvement of the right trigeminal and abducens nerve along with thick enhancement along the right pons and midbrain. MR arteriogram revealed a large filling defect within the cavernous sinus. Intraventricular gentamicin was administered via external ventricular drain (ie, ventriculostomy) every 24 hours for 14 days with continued treatment of intravenous ceftriaxone and metronidazole. The patient improved with complete resolution of her cavernous sinus meningitis on repeat brain imaging at 6 months posthospitalisation.

  • neurosurgery
  • drug therapy related to surgery
  • ear, nose and throat/otolaryngology
  • meningitis
  • infection (neurology)
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Footnotes

  • Contributors JT assisted in the surgery and was in-charge of writing the manuscript. He is guarantor. MF helped to write and edit the manuscript. DT revised and finalised the manuscript. BFR was the surgeon in-charge of the case and follow-up plan of the patient. He offered revisions and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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