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Acta Neurochirurgica

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01-05-2013 | Clinical Article -Neurosurgical Techniques

Surgery in hydrocephalus of tubercular origin: challenges and management

Authors: Apoorva Kumar, Kulwant Singh, Vivek Sharma

Published in: Acta Neurochirurgica | Issue 5/2013

Abstract

Background

Hydrocephalus of tubercular origin is one of the most dreaded and difficult to manage complications of brain tuberculosis. Traditionally, the management has been ventriculoperitoneal shunting, but in recent years emerging interest is in endoscopic ventriculostomy. In this article, we discuss the management protocol of hydrocephalus in various stages of disease.

Methods

A total of 424 cases of tubercular origin hydrocephalus were managed between years 2000 and 2009. Initially the cases were managed by ventriculoperitoneal shunting, which was followed by use of endoscopic third ventriculostomy. Drug-resistant cases were also encountered and managed according to drug sensitivity.

Results

The results provided through evaluation of retrospective data showed a high mortality in cases of hydrocephalus of acute origin if endoscopic third ventriculostomy was performed. The cerebrospinal fluid protein level and neurological status of the patient determined the success or failure of the procedure. For better management, patients were divided into six groups and their management underlined.

Conclusion

The cases of tubercular meningitis with aqueductal stenosis presenting in early stages should be given a trial of endoscopic third ventriculostomy where chronic burnt-out cases or cases with communicating hydrocephalus should be managed by ventriculoperitoneal shunting.

British Medical Research Council (1948) Streptomycin treatment of tuberculous meningitis. Br Med J 1:582–597CrossRef

Chakraborty AK (2000) Estimating mortality from tuberculous meningitis in a community: use of available epidemiological parameters in the Indian context. Indian J Tub 47:9–12

Chugh A, Husain M, Gupta RK, Ojha BK, Chandra A, Rastogi M (2009) Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy. J Neurosurg Pediatr 3(5):371–377PubMedCrossRef

Dastur DK, Manghani DK, Udani PM (1995) Pathology and pathogenetic mechanisms in neurotuberculosis. Radiol Clin North Am 33:733–752PubMed

Figaji AA, Fieggen AG, Peter JC (2003) Endoscopic third ventriculostomy in tuberculous meningitis. Childs Nerv Syst 19(4):217–225PubMed

Figaji AA, Fieggen AG, Peter JC (2007) Endoscopy for tuberculous hydrocephalus. Childs Nerv Syst 23(1):79–84PubMedCrossRef

Husain M, Jha DK, Rastogi M, Husain N, Gupta RK (2005) Role of neuroendoscopy in the management of patients with tuberculous meningitis hydrocephalus. Neurosurg Rev 28:278–283PubMedCrossRef

Katrak SM, Shembalkar PK, Rijwe SR, Bhandarkar LD (2000) The clinical, radiological and pathological profile of tuberculous meningitis to patients with and without human immunodeficiency virus infection. J Neurol Sci 181:118–126PubMedCrossRef

Lamprecht D, Schoeman J, Donald P, Hartzenberg H (2001) Ventriculoperitoneal shunting in childhood tuberculous meningitis. Br J Neurosurg 15(2):119–125PubMedCrossRef

10.

Ozates M, Kemaloglu S, Gurkan F, Ozkan U, Hosoglu S, Simsek MM (2000) CT of the brain in tuberculous meningitis. A review of 289 patients. Acta Radiol 41(1):13–17PubMedCrossRef

11.

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(1):64–69PubMedCrossRef

12.

Rajshekhar V (2009) Management of hydrocephalus in patients with tuberculous meningitis. Neurol India 57(4):368–374PubMedCrossRef

13.

Schoeman J, Donald P, van Zyl L, Keet M, Wait J (1991) Tuberculous hydrocephalus: comparison of different treatments with regard to ICP, ventricular size and clinical outcome. Dev Med Child Neurol 33:396–405PubMedCrossRef

14.

Sil K, Chatterjee S (2008) Shunting in tuberculous meningitis: a neurosurgeon’s nightmare. Childs Nerv Syst 24(9):1029–1032PubMedCrossRef

15.

Singh D, Sachdev V, Singh AK, Sinha S (2005) Endoscopic third ventriculostomy in post tubercular meningitic hydrocephalus: a preliminary report. Minim Invasive Neurosurg 48:47–52PubMedCrossRef

16.

Singh I, Haris M, Husain M, Husain N, Rastogi M, Gupta RK (2008) Role of endoscopic third ventriculostomy in patients with communicating hydrocephalus: an evaluation by MR ventriculography. Neurosurg Rev 31(3):319–325PubMedCrossRef

17.

Tandon PN (1978) Tuberculous meningitis (cranial and spinal) In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology. Infections of the nervous system, vol 33. North-Holland, Amsterdam, pp 195–262

18.

Thwaites GE, Hein TT (2005) Tuberculous meningitis: many questions, too few answers. Lancet Neurol 4:160–170PubMed

19.

Thwaites GE, Macmullen-Price J, Tran TH, Pham PM, Nguyen TD, Simmons CP, White NJ, Tran TH, Summers D, Farrar JJ (2007) Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study. Lancet Neurol 6(3):230–236PubMedCrossRef

20.

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

21.

van Well GT, Paes BF, Terwee CB, Springer P, Roord JJ, Donald PR, van Furth AM, Schoeman JF (2009) Twenty years of pediatric tuberculous meningitis: a retrospective cohort study in the western cape of South Africa. Pediatrics 123(1):1–8CrossRef

22.

Whiteman M, Espinoza L, Post MJ, Bell MD, Falcone S (1995) Central nervous system tuberculosis in HIV-infected patients: clinical and radiographic findings. AJNR Am J Neuroradiol 16:1319–1327PubMed

Title: Surgery in hydrocephalus of tubercular origin: challenges and management
Authors: Apoorva Kumar
Kulwant Singh
Vivek Sharma
Publication date: 01-05-2013
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 5/2013
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-013-1658-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgery in hydrocephalus of tubercular origin: challenges and management

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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