RT Journal Article SR Electronic T1 Use of ventriculostomy in the treatment of septic cavernous sinus thrombosis (SCST) JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e228929 DO 10.1136/bcr-2018-228929 VO 12 IS 4 A1 Justin Thomas A1 Mohamad Fayad A1 Doris Tong A1 Boyd F Richards YR 2019 UL http://casereports.bmj.com/content/12/4/e228929.abstract AB 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.