Endoscopic Third Ventriculostomy in Prepontine- Suprasellar Tuberculoma with Tuberculous Meningitis Hydrocephalus: A Case Report (original) (raw)
Related papers
Unilateral hydrocephalous: atypical presentation of intracranial tuberculoma
Turkish Neurosurgery, 2010
A 43-year-old male presented with 3-month history of low-grade fever and headache. Radiological investigations revealed unilateral hydrocephalus. Unilateral obstruction of the foramen of Monro due to chronic tubercular ependymal inflammation was suspected and endoscopic septostomy was planned. Though ventriculo-peritoneal shunt is a simple method to treat hydrocephalus, complications related to this procedure are numerous. Neuroendoscopy is a safe method to treat hydrocephalus in selected cases, and also provides access to biopsy the lesion in question. An isolated tuberculoma obstructing the foramen of Monro was seen during endoscopy. Presentation and management of this unusual tuberculoma is reported along with a review of the pertinent literature.
Surgical Neurology, 2007
Background: In recent years, ETV has been found to be effective in patients with TBMH; however, its precise selection criteria are yet to be established. We carried out this study to identify the factors affecting the outcome of ETV in TBMH. Methods: Fourteen patients with TBMH (11 male patients and 3 female patients; mean age, 15.7 years; range, 9 months to 40 years) formed the study group. Various preoperative (clinical grade, ventricular morphology, basal exudates, and CNS tuberculoma) and perioperative (ependymal tubercles, third ventricular floor anatomy, exudates, and adhesions) factors were studied with regard to the result of ETV. Endoscopic third ventriculostomy could be performed on 13 patients; however, an unidentifiable third ventricular floor anatomy precluded ETV in the remaining patient. Endoscopic third ventriculostomy was assigned as bfailedQ if the patient needed shunt, required EVD, or died in the postoperative period. The average follow-up period for the patients was 5 months. Results: Endoscopic third ventriculostomy was successful in 9 of the 14 (64.2%) patients subjected to neuroendoscopy. Statistical analysis did not show any significant association of ventricular morphology ( P = .109), basal enhancement on CT ( P = .169), CNS tuberculoma ( P = .169), and clinical grade ( P = .057) with the result of ETV, probably because of the small number of cases. However, patients with severe hyponatremia, extra-CNS tuberculosis, an unidentifiable third ventricular floor anatomy, and adhesions in the prepontine cistern had a failed ETV. Patients with tuberculoma in the brain had a successful ETV. Conclusions: Endoscopic third ventriculostomy is likely to fail in the presence of advanced clinical grade, extra-CNS tuberculosis, dense adhesions in prepontine cisterns, and an unidentifiable third ventricular floor anatomy. Tuberculoma in the brain in cases of TBMH may be associated with a successful ETV. D
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
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.
Endoscopic Third Ventriculostomy in Post-Tubercular Meningitic Hydrocephalus
min - Minimally Invasive Neurosurgery, 2006
Hydrocephalus is a common sequel of tubercular meningitis. Endoscopic third ventriculostomy (ETV) was performed in thirtyfive patients. According to the duration of illness, six patients were in the early (less than 6 weeks), nineteen were in the intermediate (6 weeks to 6 months) and ten patients were in the late phase (more than 6 months) of tubercular meningitis (TBM). Six patients were in stage I, seven patients in stage II and twentytwo patients were in stage III. The overall success rate of ETV in TBM was 77 %. Sixty percent had early and seventeen percent had delayed recovery. Obstructive hydrocephalus was present in 54.3 % and 45.7 % had communicating hydrocephalus. The radiological recovery rate was 55.6 %. The outcome with a thin to transparent floor of the third ventricle was 87 %.
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
Tuberculomas in the Cavernous Sinus, Temporal Lobe and Basal Subarachnoid Spaces
Journal of Medicine, 2012
Intracranial tuberculomas are rather common lesions in developing world. 1 The central nervous system (CNS) involvement comprises approximately 10-15% of all tuberculous infections. 2 They are commonly located in cerebral hemispheres and basal ganglia in adults, and in cerebellar hemispheres in children. 3 The other rare locations are the sellar area, cerebellopontine angle, Meckel's cave, suprasellar cistern, hypothalamic region. 4,5 Involvement of the cavernous sinus is very rare, and only less than ten cases have been reported in the literature, till today. Here we report a rare case of tuberculoma involving cavernous sinus, temporal lobe and basal subarachnoid spaces (Right cavernous sinus, left temporal lobe, right sylvian fissure, basal cistern, interpeduncular cistern and prepontine cistern).