although the rate of mortality due to brain abscess has recently been decreasing , patients with intraventricular rupture of such abscesses have a poorer outcome , and the mortality rate may be as high as 85% . no definitive therapeutic regimens for intraventricular rupture of brain abscesses have been reported , and most patients are treated by aggressive surgery . even when patients have a favorable outcome , long - term hospitalization is usually required . to our knowledge , there have been no detailed reports of such cases treated using a neuroendoscopic approach . here , we report a case of intraventricular brain abscess rupture in a patient with normal immunity that was treated successfully by neuroendoscopic aspiration of the intraventricular abscess , followed by simple ventricular drainage with intraventricular and intravenous administration of antibiotics . twelve hours later , his condition deteriorated to confusion and restlessness with nuchal stiffness after severe exacerbation of the headache and vomiting . magnetic resonance imaging ( mri ) revealed a mass with ring enhancement extending to the right ventricle ( figure 1 ) . emergency aspiration of cerebrospinal fluid ( csf ) from the spinal canal revealed severe purulent meningitis ; cells 10,112/ 3 mm ( neutrophils : 87% ) , protein : 326 mg / dl , sugar : 4 mg / dl . bacterial culture of the csf and blood was negative , and no positivity for serum endotoxin , -d glucan , or aspergillus was evident . were still present on the second day , the patient underwent evacuation of the intraventrcular abscess via the right lateral ventricle using a neuroendoscope . in the posterior horn of the lateral ventricle , whitish , soft pus was observed . using a forceps , the pus was removed , and then as much of it as possible was aspirated using a 5-ml syringe . a catheter was implanted into the ventricle , and gentamicin sulfate was administered twice a day . nine days after the operation , the csf findings recovered to normal , and the catheter was removed . culture revealed streptococcus intermedius / milleri , and therefore cefotaxime sodium was administered intravenously for 14 days , followed by oral administration of cefcapene pivoxil hydrochloride for 10 days . after 20 months of follow - up , the patient is doing well and has returned to his work . he had a history of traumatic subarachnoid hemorrhage causing mild right lower limb paresis 40 years previously , but was running a cardboard recycling company . figure 1magnetic resonance imaging revealing an area of ring enhancement in the occipital lobe with ventricular debris . magnetic resonance imaging revealing an area of ring enhancement in the occipital lobe with ventricular debris . ( a ) t1-weighted image with gadolinium enhancement , ( b ) t2-weighted image . magnetic resonance imaging showing gradual shrinkage of the mass and intraventricular debris . 
 figure 3magnetic resonance imaging demonstrating no enhanced mass . magnetic resonance imaging demonstrating no enhanced mass . intraventricular rupture of a brain abscess is still a life - threatening condition , in comparison with simple brain abscess . recommended an aggressive therapeutic plan involving open craniotomy with debridement of the abscess and ventricle lavage , followed by postoperative intravenous and intraventricular administration of antibiotics , and intraventricular drainage for 6 weeks . sato et al . suggested a minimally invasive regimen involving 14 days of intraventricular irrigation with antibiotics between the bilateral anterior horns of the lateral ventricle . however , even when the patients had a favorable outcome , long - term hospitalization was usually required . our patient was discharged only one month after admission , and intraventricular and intravenous administration of antibiotics was done for 9 days and 21 days , respectively . in cases of cerebral abscess rupturing into the ventricle , the ventricles sometimes become loculated with fibrous bands that prevent free circulation of the csf . a neuroendoscope can perforate such fibrous bands or thickened pus , and directly remove them . intrathecal and intravenous administration of antibiotics after this procedure is therefore possible and effective . in this case , it was also intriguing that bacterial cultures of csf taken via spinal puncture and from blood were negative , whereas the causative bacterium was identified from the pus collected using the neuroendoscope , even after the antibiotics had been administered . the present case may have been less serious than a number that have been reported previously . although investigation of the present procedure in such serious cases will therefore be required , we believe that an endoscopic approach is useful for minimally invasive treatment of intraventricular rupture of a brain abscess .
intraventricular rupture of a brain abscess is still associated with a high mortality rate . here , we report such a case in a patient with normal immunity that was treated successfully using neuroendoscopic approach . a 69-year - old man who had presented with headache and fever developed confusion and restlessness . 
 magnetic resonance imaging revealed a mass with ring enhancement extending to the right ventricle . 
 emergency aspiration of cerebrospinal fluid ( csf ) from the spinal canal revealed severe purulent meningitis . 
 bacterial culture of the csf and blood was negative . because of prolonged consciousness disturbance , the patient underwent evacuation of the intraventrcular abscess using a neuroendoscope . 
 the pus was centrifuged and collected for bacterial culture , and this revealed streptococcus intermedius / milleri . 
 after implantation of a ventricular catheter , gentamicin sulfate was administered twice a day for 9 days . 
 cefotaxime sodium was also administered intravenously for 14 days , followed by oral administration of cefcapene pivoxil hydrochloride for 10 days . 
 the patient made a complete recovery , and was discharged 31 days after admission . 
 after 20 months of follow - up , he is doing well and has returned to his work . in cases of intraventricular rupture of a brain abscess , a neuroendoscopic approach is useful for evacuation of intraventricular debris or septum , and identification of the causative bacterium for selection of antibiotics , possibly reducing the period of hospitalization .