Clinical Chronicle: The Use of Ventriculo-Atrial Shunt in Tuberculous Hydrocephalus Treatment (original) (raw)
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Asian journal of neurosurgery
The objective of this study was to compare safety and efficacy of endoscopic third ventriculostomy (ETV) versus ventriculoperitoneal (VP) shunt in the treatment of hydrocephalus in tuberculous meningitis (TBM) and to assess clinical and radiological profiles of patients with TBM that would be better suited to either VP shunt or ETV. This study was a single-center randomized prospective study on 52 patients with TBM hydrocephalus in the pediatric age group (<18 years of age). Patients included in the study were randomized into undergo either VP shunt or ETV. Both groups were followed up for a minimum of 5 months and assessed for success and failure rates as well as procedural complications and neurologic sequelae. Twenty-six patients underwent ETV with a success rate of 65.4% with six of nine failures occurring within the first 16 days after surgery (median time to failure - 3 days). In the VP shunt group, there was a success rate of 61.54% and a median time to failure of 50 days....
Factors influencing shunt malfunction in patients with tuberculous meningitis
Indian Journal of Neurosurgery, 2013
Hydrocephalus secondary to tuberculous meningitis (TBM) is a challenging condition to treat. Though ventriculo-peritoneal (VP) shunt is an accepted modality of treatment for hydrocephalus in TBM, there is a high rate of complications associated with the same. The study was planned to evaluate various factors associated with shunt malfunction in patients undergoing VP shunt surgery for hydrocephalus due to TBM. A retrospective review of all the patients undergoing VP shunt and shunt revision for TBM between 2004 and 2008 was performed. 449 VP shunt surgeries were performed in 432 patients for hydrocephalus due to TBM. Among these 70 shunt revisions were performed in 53 patients. Shunt malfunction rate in our series was 16.2%. High cerebrospinal fluid (CSF) protein concentration (>200 mg/dL) was associated with 5 times increased incidence of shunt malfunction. Patients with hyponatremia (Na+ <130 mEq/dL) prior to surgery had a 3 times increased incidence of shunt malfunction (P ...
Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus
Asian Journal of Neurosurgery, 2014
alternative to shunt procedures is an established treatment for obstructive hydrocephalus in TBM. [7,9-20] Role of ETV is controversial in communicating hydrocephalus and in acute phase of disease. The present article is aimed to review the role of ETV in TBM hydrocephalus. Indications of ETV in TBM hydrocephalus ETV is indicated in obstructive hydrocephalus in TBM. Most of the researchers prefer lumbar peritoneal shunt in communicating hydrocephalus, [21,22] although there are reports of ETV being performed in communicating hydrocephalus. [13,15] Endoscopic third ventriculostomy procedure ETV is technically difficult in post-infective hydrocephalus, especially in acute phase of disease due to presence of inflammation, thick and opaque floor of third ventricle. [7,10,17] It is comparatively simple in chronic phase of disease. There is an increased risk of hemorrhage and neurovascular injury, especially in acute phase. [10] Difficult cases in acute stage can be managed by water jet dissection. [10] Simple cases, in chronic phase, can be dealt by blunt perforation of the floor of third ventricle. Although ETV is technically possible in almost all cases of TBM hydrocephalus, proper case selection
International Journal of Integrated Health Sciences
Objective: To describe the clinical characteristics and complications observed in tuberculous meningitis (TBM) patients with hydrocephalus who had undergone fluid diversion management. Methods: This was a cross-sectional descriptive observational study involving 28 TBM patients with hydrocephalus aged 0-5 years who had undergone ventriculoperitoneal shunt or extraventricular drainage in the period of July 2011 to July 2016 in Dr. Hasan Sadikin General Hospital, Bandung. Age, gender, head circumferences, nutritional status, and classical characteristics such as sunset eye, frontal bossing, cracked pot sign, venectation as well as complications such as infection, phlebitis, and exposed shunt documented in the hospital medical records were analyzed. Results: The study discovered that infant group was predominant (21/28). Some of the patients had macrocephalus (7/28) and 18 had good nutrition status (18/28). There were 4 patients with frontal bossing characteristics (4/28) and almost none was found with others classic hydrocephalus characteristics. This study found no complication such as infection, phlebitis, and exposed shunt in TBM patients with hydrocephalus who had undergone fluid diversion therapy in Dr. Hasan Sadikin General Hospital, Bandung. Conclusions: One of the most dominan characteristics of TBM patients with hydrocephalus is frontal bossing. Tuberculous meningitis patients with hydrocephalus in our center did not show any fluid diversion-related complications such as infection, phlebitis, or exposed shunt.
Endoscopic third ventriculostomy for chronic hydrocephalus after tuberculous meningitis
Surgical Neurology, 2005
Background: Cerebrospinal fluid diversion procedures are indicated in patients with hydrocephalus after tuberculous meningitis (TBM). We present 2 patients with hydrocephalus after TBM who were successfully treated with endoscopic third ventriculostomy (ETV). Methods: Two patients had been diagnosed with hydrocephalus after TBM and had undergone ventriculoperitoneal shunt surgery for the same. They presented with multiple episodes of shunt dysfunction. Endoscopic third ventriculostomy was performed (twice for one patient), and the patients were evaluated clinically and radiologically after the procedure. Results: On long-term clinical follow-up (3 and 2 years, respectively), both patients were asymptomatic after the ETV. The first patient was radiologically evaluated 7 months after the procedure and the second patient 2 years after the procedure. The first patient showed a decrease in ventricular size. The second patient did not show any significant change in the ventricular size. Conclusion: Endoscopic third ventriculostomy can be considered as a safe and long-lasting solution for hydrocephalus after chronic TBM. D
Shunting in tuberculous meningitis: a neurosurgeon's nightmare
Child's Nervous System, 2008
Objective In a developing country like India, tuberculosis is very common in spite of a mass vaccination programme. Meningitis, progressive arteritis, adhesive arachnoiditis and tuberculomas represent the wide spectrum of this potentially lethal disease. Hydrocephalus occurs in about one third of the patients with central nervous system tuberculosis. Majority of patients have large fourth ventricles with adhesive obstructions in the basal cerebrospinal fluid (CSF) cisterns. Aggressive CSF diversion does not always alter the course of the disease. Endoscopic procedures are rarely, if ever, successful. Ventriculo-peritoneal shunting is fraught with complications like high rate of infection and shunt tube blockage. So there is clearly a need to explore methods of CSF diversion. Methods In our series of 32 patients, we present the indications, prognostic indicators and types of shunt with the clinical outcome of childhood tuberculous meningitis. Conclusions Even though the results are far from satisfactory, early shunting still remains the best option to prevent long-term neurological sequelae.
Outcome of Hydrocephalus in Tuberculous Meningitis. A Retrospective Study
2020
PurposeTo study outcome of Hydrocephalus in Tuberculous Meningitis (TBMH) and factors associated with poor clinical outcome.MethodsClinical data of 143 adult patients diagnosed with TBM over a 6-year period in 2 tertiary hospitals in Malaysia were retrospectively reviewed. Relevant clinical and radiological data was studied. Patients with Hydrocephalus in TBM (TBMH) were further analysed based on their clinical grade and rendered treatment to identify prognostic factors and outcome of this subgroup of patients. The functional outcome of patients was assessed at 12 months from treatment.Results The mean age of patients was 35.6P12.4 year, with a male gender predominance of 67.1%. Forty four percent had TBMH, of which 42.9% had surgical intervention. In the good Modified Vellore Grade, 76.5% was managed medically with concurrent ATT, steroids and osmotic agents. Four patients had surgery early in the disease as they did not respond to medical therapy and reported a good outcome subseq...
Endoscopic third ventriculostomy in tuberculous meningitis needs more evidence
Annals of Indian Academy of Neurology, 2012
Background: Endoscopic third ventriculostomy (ETV) is increasingly being used as an alternative treatment in tubercular meningitis (TBM) hydrocephalus. This study is aimed to evaluate the role of ETV in TBM hydrocephalus. Materials and Methods: This is a prospective study of 59 patients with TBM and obstructive hydrocephalus. The diagnosis was confirmed by a computed tomography scan and/or magnetic resonance imaging scan preoperatively. The procedure was performed using the standard technique or water jet dissection. Results: Three (5.1%) patients had blocked stoma, 31 (53%) had associated malnutrition, and 13 (22%) had complex hydrocephalus. Clinical improvement was seen in 34 (58%) after ETV and in 47 (80%) patients after ETV with lumber peritoneal shunt. Thirteen patients with patent stoma and complex hydrocephalus did not improve after ETV alone; an additional lumber peritoneal shunt was required. Clinical outcome was significantly better in good grade. Early recovery was observed in 81%. Results of ETV were better in patients without cisternal exudates, good nutritional status, thin and identifiable floor of third ventricle compared to cases with cisternal exudates, malnourished, thick and unidentifiable floor respectively, although the difference was statistically insignificant. There was no operative death. Three patients with normal ICP did not show any improvement. The radiological recovery after 3 weeks of surgery was 52%; follow-up ranged between 7 and 54 months. Six patients developed CSF leak. Conclusion: Endoscopic third ventriculostomy was safe and effective in TBM hydrocephalus. Complex hydrocephalus and associated cerebral infarcts were the major causes of failure to improve. Good results were observed in better grades.