Top

Published in:

01-10-2005 | Original Article

Role of neuroendoscopy in the management of patients with tuberculous meningitis hydrocephalus

Authors: Mazhar Husain, Deepak K. Jha, Manu Rastogi, Nuzhat Husain, Rakesh K. Gupta

Published in: Neurosurgical Review | Issue 4/2005

Abstract

The role of neuroendoscopy in patients of tuberculous meningitis with hydrocephalus (TBMH) is not yet established. We present details of endoscopic morphology, and analyze outcome of Neuroendoscopy performed in 28 patients (15 males and 13 females, average age 23 years) of TBMH in last 2.5 years. Endoscopic procedures performed included endoscopic third ventriculostomy (ETV) alone (n=19), ETV with monroplasty (n=2), and septostomy (n=2), ETV with decompression/biopsy of tuberculoma (n=2) and with abscess drainage (n=1). Outcome was assessed on the basis of clinico-radiological improvement, need for external shunt and complications. Outcome was satisfactory in 14 (50%), acceptable in five (18%) and unsatisfactory in nine (32%) patients. Overall, 19 (68%) patients benefited from endoscopic intervention. Cerebrospinal fluid (CSF) leak (n=2) and per-operative bleeding (n=1) were the only complications encountered. Endoscopy appears to be helpful in a considerable number of patients with TBMH, and should be considered as the first surgical option for CSF diversion surgery in these patients. External shunt should be reserved for those who fail the endoscopic CSF diversion.

Aoki N (1990) Lumboperitoneal shunt: clinical applications, complications, and comparison with ventriculoperitoneal shunt. Neurosurgery 26(6):998–1004CrossRefPubMed

Bhagwati SN (1971) Ventriculoatrial shunt in tuberculous meningitis with hydrocephalus. J Neurosurg 35:309–313

Bhargava S, Gupta AK, Tandon PN (1982) Tuberculous meningitis—a CT study. Br J Radiol 55(651):189–196PubMed

Bullock MMR, van Dellen JR (1982) The role of cerebrospinal fluid shunting in tuberculous meningitis. Surg Neurol 18:247–274

Chumas PD, Kulkarni AV, Drake JM, Hoffman HJ, Humphreys RP, Rutka JT (1993) Lumboperitoneal shunting: a retrospective study in the pediatric population. Neurosurgery 32(3):376–383

Cinalli G (1999) Alternatives to shunting. Childs Nerv Syst 15:718–731CrossRefPubMed

Cinalli G, Sainte-Rose C, Chumas P, Zerah M, Brunelle F, Lot G, Pierre-Kahn A, Renier D (1999) Failure of third ventriculostomy in the treatment of aqueductal stenosis in children. J Neurosurg 90(3):448–454PubMed

Cinalli G, Salazar C, Mallucci C, Yada JZ, Zerah M, Sainte-Rose C (1998) The role of endoscopic third ventriculostomy in the management of shunt malfunction: clinical study. Neurosurgery 43(6):1323–1329CrossRefPubMed

Dastur DK, Lalitha VS, Udani PM, Parekh UC (1970) The brain and meninges in tuberculous meningitis. Gross pathology in 100 cases and pathogenesis. Neurol India 18:86–100PubMed

10.

Elad Y, Nelson PJ, Meier DE (1998) Jumping to the wrong conclusion. N Engl J Med 339:1382–1387

11.

Fallon RJ, Kennedy DH (1981) Treatment and prognosis of in tuberculous meningitis. J Infect (Suppl 1):39–44

12.

Figaji AA, Fieggen AG, Peter JC (2003) Endoscopic third ventriculostomy in tuberculous meningitis. Childs Nerv Syst 19:217–225CrossRefPubMed

13.

Fukuhara T, Vorster SJ, Luciano MG (2000) Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurgery 46:1100–1109CrossRefPubMed

14.

Gelabert M, Castro-Gago M (1988) Hydrocephalus and tuberculous meningitis in children. Childs Nerv Syst 4:268–270PubMed

15.

Greitz D (2004) Radiological assessment of hydrocephalus: new theories and implications for therapy. Neurosurg Rev 27(3):145–65PubMed

16.

Greitz D, Greitz T, Hindmarsh T (1997) A new view on the CSF-circulation with the potential for pharmacological treatment of childhood hydrocephalus. Acta Paediatr 86(2):125–132PubMed

17.

Greitz D, Hannerz J (1996) A proposed model of cerebrospinal fluid circulation: observations with radionuclide cisternography. Am J Neuroradiol 17:431–438PubMed

18.

Gupta RK, Gupta S, Singh D, Sharma B, Kohli A, Gujral RB (1994) MR imaging and angiography in tuberculous meningitis. Neuroradiology 36:87–92CrossRefPubMed

19.

Gupta RK, Kathuria MK, Pradhan S (1999) Magnetization transfer MR imaging in CNS tuberculosis. Am J Neuroradiol 20:867–875PubMed

20.

Hirsch JF, Hirsch E, Sainte-Rose C, Renier D, Pierre-Kahn A (1986) Etiology and treatment. J Neurosurg Sci 30:29–39PubMed

21.

Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A (1999) Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 44(4):795–806CrossRefPubMed

22.

Hosoglu S, Ayaz C, Geyik MF, Kokoglu MF, Ceviz A (1998) Tuberculours meningitis in adults: an eleven-year review. Int J Tuberc Lung Dis 2:553–557PubMed

23.

Husain M, Jha D, Thaman D, Husain N, Gupta RK (2004) Ventriculostomy in a tumor involving the third ventricular floor. Neurosurg Rev 27(1):70–72CrossRefPubMed

24.

Husain M, Jha D, Vatsal DK, Thaman D, Gupta A, Husain N, Gupta RK (2003) Neuroendoscopic surgery- experience and outcome analysis of 102 consecutive procedures in a busy neurosurgical centre of India. Acta Neurochir (Wien) 145(5):369–376

25.

Jinkins JR, Gupta RK, Chang KH, Rodriguez-Carbajal J (1995) MR imaging of central nervous system tuberculosis. Radiol Clin N Am 33(4):771–786PubMed

26.

Jones RFC, Teo C, Steining WA, Kwok BCT (1992) Neuroendoscopic third ventriculostomy. In: Manwaring KH, Crone KR (eds) Neuroendoscopy, vol 1. Mary Ann Liebert Publishers, Larchmont, pp 63–77

27.

Jones RF, Kwok BC, Steining WA, Vonau M (1994) The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invasive Neurosurg 37:28–36PubMed

28.

Jones RF, Kwok BC, Steining WA, Vonau M (1994) Neuroendoscopic third ventriculostomy: a practical alternative to extracranial shunts in non-communicating hydrocephalus. Acta Neurochir Suppl (Wien) 61:79–83

29.

Joosten AAJ, van der Valk PDLPM, Geelen JAG, Severin WPJ, Jansen Steur ENH (2000) Tubercular meningitis: pitfalls in diagnosis. Acta Neurol Scand 102:388–394

30.

Kamra P, Azad R, Prasad KN, Jha S, Pradhan S, Gupta RK (2004) Infectious meningitis: prospective evaluation with magnetization transfer MRI. Br J Radiol 77(917):387–394CrossRefPubMed

31.

Kang S (2000) Efficacy of lumbo-peritoneal versus ventriculo-peritoneal shunting for management of chronic hydrocephalus following aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 142(1):45–49CrossRef

32.

Kehler U, Gliemroth J, Knopp U, Arnold H (1998) The role of third ventriculostomy in previously shunted hydrocephalus. In: Hellwig D, Bauer BL (eds) Minimally invasive techniques for neurosurgery. Springer, Berlin Heidelberg New York, pp 77–80

33.

Kemaloglu S, Özkan Ü, Bukte Y, Ceviz A, Özates M (2002) Timing of shunt surgery in childhood tuberculous meningitis with hydrocephalus. Pediatr Neurosurg 37:194–198CrossRefPubMed

34.

Kristensen B, Malm J, Markgren P, Ekstedt J (1992) CSF hydrodynamics in superior sagittal sinus thrombosis. J Neurol Neurosurg Psychiatry 55(4):287–293PubMed

35.

Kumar R, Singh SN, Kohli N (1999) A diagnostic rule for tuberculous meningitis. Arch Dis Child 81:221–224PubMed

36.

Lamprecht D, Schoeman J, Donald P, Hartzenberg H (2001) Ventriculoperitoneal shunting in childhood tuberculous meningitis. Br J Neurosurg 15:119–125CrossRefPubMed

37.

Mathew JM, Rajshekhar V, Chandy MJ (1998) Shunt surgery in poor grade patients with tuberculous meningitis and hydrocephalus: effects of response to external ventricular drainage and other variables on long term outcome. J Neurol Neurosurg Psychiatry 65:115–118PubMed

38.

Mishra UK, Kalita J, Roy AK, Mandal SK, Srivastava M (2000) Role of clinical, radiological, and neurophysiological changes in predicting the outcome of tuberculous meningitis: a multivariable analysis. J Neurol Neurosurg Psychiatry 68:300–303CrossRefPubMed

39.

Murray HW, Brandstetter RD, Lavyne MH (1981) Ventriculoatrial shunting for hydrocephalus complicating tuberculous meningitis. Am J Med 70:895–898

40.

Palur R, Rajshekhar V, Chandy MJ, Joseph T, Abraham J (1991) Shunt surgery for hydrocephalus in tuberculous meningitis: a long term follow-up study. J Neurosurg 74:64–69PubMed

41.

Bhadelia RA, Bogdan AR, Wolpert SM (1995) Analysis of cerebrospinal fluid flow waveforms with gated phase-contrast MR velocity measurements. Am J Neuroradiol 16(2):389–400PubMed

42.

Sainte-Rose C (1992) Third ventriculostomy. In: Manwaring KH, Crone KR (eds) Neuroendoscopy, vol 1. Mary Ann Liebert Publishers, Larchmont, pp 47–62

43.

Scarrow AM, Levy EI, Pascucci L, Albright AL (2000) Outcome analysis of endoscopic III ventriculostomy. Childs Nerv Syst 16(7):442–445CrossRefPubMed

44.

Schoeman JF, Van Zyl LE, Laubscher JA, Donald PR (1997) Effect of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis. Pediatrics 99(2):226–231CrossRefPubMed

45.

Schwartz TH, Yoon SS, Cutruzzola FW, Goodman RR (1996) Third ventriculostomy: post-operative ventricular size and outcome. Minim Invasive Neurosurg 39(4):122–129PubMed

46.

Siomin V, Cinalli G, Grotenhuis A, Golash A, Oi S, Kothbauer K, Weiner H, Roth J, Beni-Adani L, Pierre-Kahn A, Takahashi Y, Mallucci C, Abbott R, Wisoff J, Constantini C (2002) Endoscopic third ventriculostomy in patients after cerebrospinal fluid infection and/or hemorrhage. J Neurosurg 97:519–524PubMed

47.

Sufainov AA, Il’ina GP, Frolova EV (2001) Endoscopic ventriculocisternostomy in the treatment of complications of tuberculous meningoencephalitis in an infant. Probl Tuberk 1:48–51PubMed

48.

Tan EK, Chee MWI, Chan LI, Lee YL (1999) Culture positive tuberculous meningitis: clinical indications of poor prognosis. Clin Neurol Neurosurg 101:157–160CrossRefPubMed

49.

Thomas MD, Copra JS, Banerjee AK, Singh MS (1997) Tuberculous meningitis: a clinicopathological study. Neurol India 25:26–34

50.

Udani PM, Parekh UC, Dastur DK (1971) Neurological and related syndromes in CNS tuberculosis: clinical features and pathogenesis. J Neurol Sci 14:341–357CrossRefPubMed

51.

Zumla A, Grange JM (1999) Doing something about tuberculosis. BMJ 318:956PubMed

Title: Role of neuroendoscopy in the management of patients with tuberculous meningitis hydrocephalus
Authors: Mazhar Husain
Deepak K. Jha
Manu Rastogi
Nuzhat Husain
Rakesh K. Gupta
Publication date: 01-10-2005
Publisher: Springer-Verlag
Published in: Neurosurgical Review / Issue 4/2005
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-005-0397-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Role of neuroendoscopy in the management of patients with tuberculous meningitis hydrocephalus

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2005

Cranial nerve assessment in posterior fossa tumors with fast imaging employing steady-state acquisition (FIESTA)

Chronic changes in cerebrospinal fluid pathways produced by subarachnoid kaolin injection and experimental spinal cord trauma in the rabbit: their relationship with the development of spinal deformity

Subependymal giant cell astrocytoma and concordant expression in a disease of variable penetrance

Intramedullary spinal cord gangliocytoma: case report and a review of the literature

Role of biofilms in neurosurgical device-related infections

Spondylodiscitis after lumbar microdiscectomy: effectiveness of two protocols of intraoperative antibiotic prophylaxis in 1167 cases