History of the Management of Meningitis and Ventriculitis in Children

Understanding of Disease

• 1600s – meningitis described: Thomas Willis described patients with “inflammation of the meninges with a continual fever” as early as the 1600s.
• 1768 – TB meningitis described: Robert Whytt provided a classic description of the findings in TB meningitis in a report published after his death in 1768.
• 1800s – causative organisms described: Organisms causing meningitis were first identified in the late 1800s, including Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.
• 1944 – antibiotics introduced: The treatment of meningitis began with antiserum therapy for meningococcal meningitis (Joachmann) in 1906, but the introduction of penicillin therapy in 1944 provided the first effective treatment for meningitis.
• 1990s v introduction of vaccine for H. influenzae meningitis: The introduction of a vaccine for H. influenzae type b in the 1990s provided a marked reduction in the incidence of H. influenzae type b meningitis.
• 2002 – demonstration of benefit of corticosteroid therapy: Corticosteroid therapy was demonstrated to improve prognosis in patients with bacterial meningitis in 2002.

Technological Development

• Lumbar puncture: Although meningitis and ventriculitis have long been recognized by pathological analysis at autopsy, the development of needle lumbar puncture in 1891 by Quinke (80) and later development of ventricular puncture by Dandy (81) allowed the diagnosis to be made in vivo.
• Antibiotics and corticosteroids: Until the modern antibiotic era, effective treatment was not possible. With more recent improvements in critical care and neurosurgical techniques, along with newer, more potent antibiotics, and the use of corticosteroids, the survival rate has improved, although significant risk of morbidity persists.
• Vaccinations: Immunization and improvements in public health hold the keys to decreasing the incidence and consequences of these infections. With the introduction of H. influenzae type b conjugate vaccines in 1990, there has been a dramatic decline in H. influenzae type b meningitis in developed countries. Similarly, the introduction of pneumococcal vaccines in 2000 resulted in a dramatic decrease in pneumococcal meningitis. Although there are vaccines against several serotypes of meningococcus, there is as yet no effective vaccine against the most common, serotype B.

Surgical Technique

The treatment of meningitis and ventriculitis is primarily medical, although complications of either condition may necessitate surgery.

• Late 20th century – minimally invasive options: Stereotactic (modern frame-based and frameless techniques) and endoscopic techniques offer minimally invasive options for drainage of loculated infections.

• Effective management of complicating hydrocephalus: Hydrocephalus, either acute or chronic, may require serial lumbar punctures, ventricular drainage, or chronic shunting. The development of modern shunt valves, beginning in the 1950s, revolutionized the treatment of hydrocephalus.