xinlinjushi ：To @Prof. Li Xiaoyong Question: Hi Prof. Li, can antibiotics be given directly via the cerebrospinal fluid route for severe intracranial infections, such as through the lumbar pool drainage tube, and how to choose antibiotics? Prof. Li Xiaoyong: The cerebrospinal fluid route is a very good route of administration, and the injection of antibiotics through the lumbar pool drainage tube is only one way, and intracerebroventricular administration is also available. However, it should be noted that intracerebroventricular administration should be better than lumbar pool administration, because the former is in the direction of cerebrospinal fluid flow and the latter is in the direction of counterflow. Of course, intracerebroventricular medication also has many technical aspects and is not suitable for adoption by neurologists or ICU physicians. How to use antibiotics, you can refer to other answers, involving the intracranial primary disease and its treatment, your hospital belongs to the general or special level of cerebrospinal fluid disease, the use of empirical medication and bacterial culture results after the timely adjustment of the treatment strategy, all these aspects need to be carefully considered. Tiger2008007 : Question to @Prof. Li Xiaoyong: Dear Director Li, for intracerebroventricular infection with Acinetobacter baumannii, Taiwan and Hong Kong advocate polymyxin E. But it is not available in China. Can we sometimes use bilateral ventricular frontal horn drilling and connect one side to a sling to drip antibiotic saline and the other side to drain externally? Could you please comment on this method? For intracerebroventricular infections, there is also a proposal to use ventriculoscopy to remove the pus fetus microscopically and flush with dilute iodine. How about this method? Prof. Li Xiaoyong: The ventricular perfusion method is a method that has been reported in China since early (note: around the 1970s) and has not shown any advantages until now. The combination of ventricular perfusion and intraventricular injection of antibiotics you mentioned should be an effective method, but the other side of the drainage does not make much sense in terms of treatment principle, but is just a mechanical imitation or modification, because ventricular perfusion does not have the effect of flushing out bacteria. In addition, your proposed method of flushing or removing the pus moss with ventriculoscopy is not fundamentally different from the method of ventricular lavage, and every year we accept patients whose infection persists or gets worse after ventriculoscopic flushing of the pus moss, which has been well proven to be ineffective or even harmful not only in terms of treatment principle but also in practice. As you can imagine: the moss on the rocks of the ravine will not disappear because of the repeated flushing of the river water over the years, and the same is true for the bacteria! Also the method of using dilute iodine to flush the infected foci is something we have no experience with, but I think that even if it is effective it is effective at a very small rate, because shunting the infection requires a certain period of time and not just a momentary anti-infective treatment during surgery, and also whether it produces chemical damage to the brain from the iodine is of concern.