Shunt surgery for hydrocephalus in tuberculous meningitis: a long-term follow-up study

Abstract

Hydrocephalus is a common complication of tuberculous meningitis. Case studies of 114 patients with tuberculous meningitis and hydrocephalus, who underwent shunt surgery between July, 1975, and June, 1986, were reviewed to evaluate the long-term outcome and to outline a management protocol for these patients based on the results. Seven factors were studied in each case: 1) age at admission; 2) grade on admission (I to IV, classified by the authors; Grade I being the best and Grade IV being the worst); 3) duration of alteration of sensorium; 4) cerebrospinal fluid (CSF) cell content at initial examination; 5) CSF protein levels at initial examination; 6) number of shunt revisions required; and 7) the necessity for bilateral shunts. During a long-term follow-up period ranging from 6 months to 13 years (mean 45.6 months), the mortality rate was 20% for patients in Grade I; 34.7% for patients in Grade II; 51.9% for patients in Grade III; and 100% for patients in Grade IV. Only the grade at the time of admission was found to be statistically significant in determining final outcome (p less than 0.001). Based on these results, the authors advocate early shunt surgery for Grade I and II patients. For patients in Grade III, surgery may be performed either if external ventricular drainage causes an improvement in sensorium or without selection. All patients in Grade IV should undergo external ventricular drainage and only those who show a significant change in their neurological status within 24 to 48 hours of drainage, should have shunt surgery.

Outcome analysis of ventriculoperitoneal shunt procedures in hydrocephalus due to tubercular meningitis and non-infective cases

“…7 Palur et al reported that 26 of 114 (22.8%) patients had to undergo one or more shunt revisions, one patient requiring more than three revisions. 8 Sil and Chatterjee reported a shunt infection rate of 15.6% and revision rate of 43.8% in their series of 37 children who underwent shunt surgery for TBM with hydrocephalus. Multiple revisions were done in 18.7% of patients.…”

Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects

“…The role of VPS and the timing of its use in children are controversial. Several groups have advocated performing VPS early in the clinical course of hydrocephalus, especially in mild-to moderate-grade cases (grade I/II/III according to the neurosurgical grading system described by Palur et al) (147) and performing a trial of external drainage in extremely poorgrade cases (grade IV cases) (95, 126, 147), whereas others endorse VPS only for those with noncommunicating hydrocephalus or those failing antibiotic therapy with communicating hydrocephalus (109,183). When the role of VPS has been examined for TBM-associated hydrocephalus, success rates ranged between 40 to 50%, and VPS has a complication rate of around 30% (1,109).…”

Cerebral infarction related to cryptococcal meningitis in an HIV-infected patient: case report and literature review

“…The basal exudates of chronic meningitis are usually most severe at the circle of Willis, which might explain why cerebral infarctions are frequently located in this area [40,41].…”