Intracranial infection is a disease caused by pathogenic organisms invading the brain, and common symptoms include meningeal irritation, increased intracranial pressure, and symptoms of systemic infection with impaired consciousness. Intracranial infection is a serious postoperative complication of neurosurgery, leading to disability and death, with low morbidity but serious consequences. Patients admitted to the First People’s Hospital of Jingzhou City for craniotomy from January 2016 to June 2022 were collected and selected, with 20 cases of infections. Under the premise of systemic application of sensitive antibiotics, continuous drainage of the lumbar pool was used, while antibiotics were injected into the subarachnoid space through the drainage tube, and 20 patients were cured with efficacy, as reported below.

All 20 patients in this group were discharged with disappearance of clinical symptoms, normal cerebrospinal fluid biochemical indexes, and negative cerebrospinal fluid microbiological culture. No complications such as subcutaneous fluid accumulation at the lumbar puncture site or cerebrospinal fluid leakage were observed in all patients.

Intracranial infections after neurosurgery include infections caused by microorganisms such as bacteria, fungi and viruses, the most common of which are bacterial infections [1], and the incidence of intracranial infections after neurosurgery is 1.8% [2]. Domestic expert consensus recommends [3] that the criteria for confirming the diagnosis of intracranial infection: 1) The clinical diagnosis of intracranial infection is established when the patient presents with fever, symptoms of cranial hypertension, cloudy or purulent cerebrospinal fluid, leukocytosis, glucose < 2.2 mmol/L and cerebrospinal fluid glucose level/serum glucose level ≤ 0.4. 2) On the basis of clinical diagnosis, a positive microbiological culture of specimen smear, drainage tip, implant and cerebrospinal fluid was present and the pathogenic diagnosis was established. Intracranial infection is a common complication after craniotomy, which seriously affects the prognosis of surgery [4] and has a high rate of disability and death [5]. Therefore, the detection of intracranial infections should be timely, early diagnosis and aggressive treatment is the key to improve prognosis, reduce clinical costs and shorten the number of hospital days. The clinical gold standard for diagnosis is a positive microbiological culture of cerebrospinal fluid [6]. There are three common clinical treatments for intracranial infections: 1) antibiotic use alone, 2) antibiotics plus lumbar puncture drainage, and 3) antibiotics plus continuous drainage of the lumbar pool. When bacterial infection of the central nervous system is clinically suspected, cerebrospinal fluid, surgical incision secretions and blood specimens should be retained for routine, biochemical, smear, bacterial culture and drug sensitivity testing before antimicrobial use; empirical antimicrobial therapy should be administered as early as possible [7]. Antimicrobial agents that readily cross the blood-brain barrier are preferred, such as ceftriaxone, cefotaxime, meropenem, and vancomycin [3]. In case of poor clinical outcome, the diagnosis needs to be reconsidered; when intracranial infection is still suspected, lumbar puncture to release cerebrospinal fluid to reduce intracranial pressure as well as intrathecal injection of drugs can be chosen but repeated multiple lumbar punctures to release cerebrospinal fluid can cause a lot of pain to the patient [8]. Intrathecal injection is easy to operate, less invasive, and enables the drug to enter the subarachnoid space directly without crossing the blood-brain barrier, with high drug concentration in the cerebrospinal fluid and good results [9]. Continuous drainage of the lumbar pool is a well-established clinical technique, and the use of this procedure allows both cerebrospinal fluid release and intrathecal drug injection, a method that can significantly improve patient healing. Under the premise of treatment with antibiotic drugs, catheter drainage can promptly eliminate intracranial bacteria and toxins, reduce meningeal irritation, and shorten the treatment time [10]. Continuous lumbar pool drainage is a well-established clinical technique that was initially applied to treat or prevent cerebrospinal fluid leakage after cranial and spinal surgery [11]. Lumbar puncture can measure intracranial pressure and collect cerebrospinal fluid for culture and biochemical indexes, and continuous drainage of the lumbar pool can also measure intracranial pressure and collect cerebrospinal fluid for culture and biochemical indexes [12]. However, the success rate of bacterial culture of cerebrospinal fluid in intracranial infections in clinical practice is low, requiring repeated and multiple cultures and biochemical indicators [13]; continuous lumbar pool drainage has significant advantages in the treatment of intracranial infections, such as the advantages of requiring only a single lumbar puncture, high success rate, controlled drainage rate, avoidance of associated adverse effects, easy detection of drained cerebrospinal fluid, and large cumulative drainage volume [14].

In conclusion, lumbar pool drainage combined with intrathecal injection and systemic application of antibiotics for the treatment of intracranial infections can reduce patients’ pain, economic burden and hospitalization time, and is a safe and effective treatment method worth promoting.

The authors declare no conflicts of interest regarding the publication of this paper.

Shi, L.Z. and Chen, S.J. (2022) Clinical Analysis of Lumbar Pool Drainage Combined with Antibiotics in the Treatment of Intracranial Infection. Journal of Biosciences and Medicines, 10, 64-68. https://doi.org/10.4236/jbm.2022.1011005