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BMC Neurology
Published in: BMC Neurology 1/2018

Open Access 01-12-2018 | Research article

Intracisternal tuberculoma: a refractory type of tuberculoma indicating surgical intervention

Authors: Fanfan Chen, Lei Chen, Yongfu Cao, Yongjun Yi, Jingwen Zhuang, Wuhua Le, Wei Xie, Lanbo Tu, Peng Li, Yimin Fang, Ling Li, Yuqing Kou, Kaikai Fu, Hua He, Hongbin Ju

Published in: BMC Neurology | Issue 1/2018

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Abstract

Background

Central nervous system (CNS) tuberculoma is a rare disease with severe neurological deficits. This retrospective research is to review the data of patients diagnosed as CNS tuberculoma. Surgeries were performed in all patients. The clinical features especially the neurological image and the anatomical characters of the tuberculomas were concerned.

Methods

Totally 11 patients diagnosed as CNS tuberculoma were admitted in Guangzhou First People’s Hospital (7cases) and Changzheng Hospital (4 cases) during 2006–2015. The data including preoperative condition, neurological imaging, and surgical findings was collected and analyzed.

Results

The lesions of nine patients (9/11) were totally or subtotally excised and two (2/11) were partially excised. Neurological functions of all patients were improved after surgery without secondary infection. Lesions of nine (9/11) patients preoperatively progressed as a result of paradoxical reaction. Of the 9 patients demonstrated paradoxical progression, all lesions were partially or totally located at the cisterns or the subarachnoid space. Preoperative ATTs lasted 2 to 12 months and tuberculomas were not eliminated. The arachnoid was found thickened and tightly adhered to the lesions during surgeries. Of the 2 cases that paradoxical reaction were excluded, both patients (case 6, intramedullary tuberculoma; case 11, intradural extramedullary tuberculoma) were admitted at onset of the disease. ATTs were preoperatively given for 1 week as neurological deficits aggravated. The tuberculous lesions of CNS or other system showed no obvious change and paradoxical reaction could not be established in both cases.

Conclusions

Exudates of tuberculosis is usually accumulated in the cisterns and frequently results in the paradoxical formation of tuberculoma. Intracisternal tuberculoma is closely related to paradoxical reaction and refractory to anti-tuberculosis therapy. Micro-surgical excision is safe and effective. Early surgical intervention may be considered in the diagnosis of intracisternal tuberculoma especially when paradoxical reaction participates in the development of tuberculoma.
Literature
1.
DeLance AR, Safaee M, MC O, Clark AJ, Kaur G, Sun MZ, Bollen AW, Phillips JJ, Parsa AT. Tuberculoma of the central nervous system. J Clin Neurosci. 2013;20(10):1333–41.CrossRefPubMed
2.
Skendros P, Kamaria F, Kontopoulos V, Tsitouridis I, Sidiropoulos L. Intradural, eextramedullary tuberculoma of the spinal cord as a complication of tuberculous meningitis. Infection. 2003;31(2):115–7.CrossRefPubMed
3.
Das KK, Jaiswal S, Shukla M, Srivastava AK, Behari S, Kumar R. Concurrent cerebellar and cervical intramedullary tuberculoma: paradoxical response on antitubercular chemotherapy and need for surgery. J Pediatr Neurosci. 2014;9(2):162–5.CrossRefPubMedPubMedCentral
4.
Luo L, Pino J. An intradural extramedullary tuberculoma of the spinal cord in a non-HIV-infected patient: case report and review of the literature. Lung. 2006;184(3):187–93.CrossRefPubMed
5.
Dastur HM. Diagnosis and neurosurgical treatment of tuberculous disease of the CNS. Neurosurg Rev. 1983;6(3):111–7.CrossRefPubMed
6.
Thwaites GE, van Toorn R, Schoeman J. Tuberculous meningitis: more questions, still too few answers. The Lancet Neurology. 2013;12(10):999–1010.CrossRefPubMed
7.
Muthukumar N, Sureshkumar V, Ramesh VG. En plaque intradural extramedullary spinal tuberculoma and concurrent intracranial tuberculomas: paradoxical response to antituberculous therapy. Case report. Journal of neurosurgery Spine. 2007;6(2):169–73.CrossRefPubMed
8.
9.
10.
Botturi A, Prodi E, Silvani A, Gaviani P, Vanoli G, Carbone A, Salmaggi A. Brain tuberculoma (Mycobacterium Africanum): high index of suspicion helps in avoiding biopsy/surgery. Neurol Sci. 2012;33(2):363–5.CrossRefPubMed
11.
Roca B. Intradural extramedullary tuberculoma of the spinal cord: a review of reported cases. The Journal of infection. 2005;50(5):425–31.CrossRefPubMed
12.
Shingade RG, Prakashchandra SP. Role of advanced diagnostic imaging in intracranial Tuberculoma: MR spectroscopy. J Clin Diagn Res. 2015;9(8):TJ03–4.PubMedPubMedCentral
13.
Akhaddar A, El Hassani MY, Chakir N, Jiddane M. Optochiasmatic tuberculoma: complication of tuberculous meningitis. Report of a case and review of the literature. Journal of neuroradiology Journal de neuroradiologie. 2001;28(2):137–42.PubMed
14.
Chang KH, Han MH, Choi YW, Kim IO, Han MC, Kim CW. Tuberculous arachnoiditis of the spine: findings on myelography, CT, and MR imaging. AJNR Am J Neuroradiol. 1989;10(6):1255–62.PubMed
15.
Afghani B, Lieberman JM. Paradoxical enlargement or development of intracranial tuberculomas during therapy: case report and review. Clin Infect Dis. 1994;19(6):1092–9.CrossRefPubMed
16.
Nicolls DJ, King M, Holland D, Bala J, del Rio C. Intracranial tuberculomas developing while on therapy for pulmonary tuberculosis. Lancet Infect Dis. 2005;5(12):795–801.CrossRefPubMed
17.
18.
Verma R, Patil TB, Lalla R. Tuberculous optochiasmatic arachnoiditis. J Global Infect Dis. 2014;6(2):89.CrossRef
19.
Idris MN, Sokrab TE, Arbab MA, Ahmed AE, El Rasoul H, Ali S, Elzubair MA, Mirgani SM. Tuberculoma of the brain: a series of 16 cases treated with anti-tuberculosis drugs. The international journal of tuberculosis and lung disease. 2007;11(1):91–5.PubMed
20.
21.
22.
Fox GJ, Mitnick CD, Benedetti A, Chan ED, Becerra M, Chiang CY, Keshavjee S, Koh WJ, Shiraishi Y, Viiklepp P, et al. Surgery as an adjunctive treatment for multidrug-resistant tuberculosis: an individual patient data Metaanalysis. Clin Infect Dis. 2016;62(7):887–95.CrossRefPubMed
23.
Garg RK, Malhotra HS, Kumar N. Paradoxical reaction in HIV negative tuberculous meningitis. J Neurol Sci. 2014;340(1–2):26–36.CrossRefPubMed
24.
Garg RK, Paliwal V, Malhotra HS. Tuberculous optochiasmatic arachnoiditis: a devastating form of tuberculous meningitis. Expert Rev Anti-Infect Ther. 2011;9(9):719–29.CrossRefPubMed
25.
Sinha MK, Garg RK, Anuradha HK, Agarwal A, Parihar A, Mandhani PA. Paradoxical vision loss associated with optochiasmatic tuberculoma in tuberculous meningitis: a report of 8 patients. The Journal of infection. 2010;60(6):458–66.CrossRefPubMed
26.
Jha D, Khatri P, Choudhary A, Sethi R, Kumar S. Endoscopic third ventriculostomy in prepontine-suprasellar tuberculoma with tuberculous meningitis hydrocephalus: a case report. Pediatr Neurosurg. 2007;43(1):42–6.CrossRefPubMed
27.
Schoeman JF, Van Zyl LE, Laubscher JA, Donald PR, Serial CT. Scanning in childhood tuberculous meningitis: prognostic features in 198 cases. J Child Neurol. 1995;10(4):320–9.CrossRefPubMed
28.
Metadata
Title
Intracisternal tuberculoma: a refractory type of tuberculoma indicating surgical intervention
Authors
Fanfan Chen
Lei Chen
Yongfu Cao
Yongjun Yi
Jingwen Zhuang
Wuhua Le
Wei Xie
Lanbo Tu
Peng Li
Yimin Fang
Ling Li
Yuqing Kou
Kaikai Fu
Hua He
Hongbin Ju
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2018
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-017-0996-x

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