A Subcutaneous Reservoir for Intrathecal Therapy of Fungal Meningitis

Subcutaneous cerebrospinal-fluid reservoirs were inserted into 15 patients with cryptococcal meningitis, four with coccidioidal meningitis, and two with chronic meningitis of undetermined cause. Complications associated with 17 reservoirs in 12 patients necessitated reservoir removal or prevented later use for intrathecal therapy. Nine of these complications were related to reservoir insertion, and eight to problems related to later usage. Insertion may have been a contributing cause of death in three patients and of neurologic deterioration in another four. In nine patients there were 10 cerebrospinal-fluid bacterial infections apparently related to reservoir usage or insertion. Reservoirs were cleared of bacterial infection and continued to be functional in four of the five patients who completed a course of treatment with antibiotics alone. Successful anti-fungal therapy was clearly attributable to intraventricular therapy in three patients with cryptococcosis and three with coccidioidomycosis. Advantages of this mode of therapy should be carefully weighed against potential risks in patients with cryptococcosis, in whom the value of intrathecal therapy is not uniformly accepted.