The Outcome of Surgical Intervention (Ventriculoperitoneal Shunt and Endoscopic Third Ventriculostomy) in Patients With Hydrocephalus Secondary to Tuberculous Meningitis: A Systematic Review

Chalasani, Roopa; Goonathilake, Mastiyage R; Waqar, Sara; George, Sheeba; Jean-Baptiste, Wilford; Ali, Amina Yusuf; Inyang, Bithaiah; Koshy, Feeba Sam; George, Kitty; Poudel, Prakar; Mohammed, Lubna

doi:10.7759/cureus.25317

Cited by 6 publications

(8 citation statements)

References 23 publications

(53 reference statements)

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“…All children underwent early permanent CSF diversion, thus allowing focus on the medical management of TBM and its complications. Majority of children (84%) in our study were treated with VPS, and the shunt complication rate was 27%, which falls within the reported range of 10 to 40% [ 13 , 44 – 47 ].…”

Section: Discussionsupporting

confidence: 77%

“…In HIV infection, TBM can present with atypical CSF results, including normal CSF, further complicating diagnosis and potentially causing delays [ 12 ]. Delayed initiation of medical treatment can lead to long-term neuro-disabilities caused by various insults to the CNS, hydrocephalus, and increased intracranial pressure (ICP) [ 13 ]. Left untreated, hydrocephalus can lead to visual deterioration, coma, and even death.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with in-hospital mortality in HIV-infected children treated for tuberculous meningitis hydrocephalus

Enicker,

Aldous

2023

Childs Nerv Syst

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Purpose The study aimed to investigate factors associated with in-hospital mortality in children diagnosed with tuberculous meningitis (TBM) hydrocephalus and HIV co-infection undergoing cerebrospinal fluid diversion procedures and their complications. Methods Data were collected retrospectively and prospectively between 2007 and 2022. Data collected included demographics, clinical characteristics, antiretroviral therapy (ART) status, biochemistry results, CD4 count, radiology findings, CSF diversion procedures (and complications), length of hospital stay (LOHS), and in-hospital mortality. Results Thirty-one children were included, with a mean age of 6.7 ± 5.3 years and 67.7% males. Median admission Glasgow Coma Scale (GCS) was 11 (IQR 9–15). Hypertonia (64.5%) and seizures (51.6%) were frequently observed clinical characteristics. Sixty-one percent of children were on ART. Cerebral infarcts and extra-meningeal TB were diagnosed in 64.5% and 19.3% of cases, respectively. The median CD4 count was 151 (IQR 70–732) cells/µL. Surgical procedures included ventriculoperitoneal shunt (VPS) in 26 cases and endoscopic third ventriculostomy (ETV) in five children. VPS complication rate was 27%. No complications were reported for ETV. Median LOHS was 7 days (IQR 4–21). Eleven children (35.5%) died during admission. Factors associated with mortality included GCS (p = 0.032), infarcts (p = 0.004), extra-meningeal TB (p = 0.003), VPS infection (p = 0.018), low CD4 count (p = 0.009), and hyponatremia (p = 0.002). No statistically significant factors were associated with VPS complications. Conclusion TBM hydrocephalus in HIV-infected children carries a high mortality. Clinicians in high-prevalence settings should have a high suspicion index and institute early treatment.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Factors associated with in-hospital mortality in HIV-infected children treated for tuberculous meningitis hydrocephalus

Enicker,

Aldous

2023

Childs Nerv Syst

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“…VPS insertion done for the management of such a type of hydrocephalus is also associated with complications, and it ranged from 10% to 44% of the cases. [ 27 - 29 ] In the present study, in n = 72 (21.42%) children, VPS catheter was inserted for the treatment of hydrocephalus secondary to TBM. A total of n = 7 (9.72%) children from this group constituted 23.33% of the children recruited for the present study, developed complications and required shunt revisions in the follow-up period.…”

Section: Discussionmentioning

confidence: 96%

Management of Ventriculoperitoneal Shunt Complications in Children

Ghritlaharey¹

2023

African Journal of Paediatric Surgery

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Objectives: The primary objective of this study was to analyse the demographics of the children who presented with ventriculoperitoneal shunt (VPS) complications. The secondary objectives were to review the clinical characteristics, surgical procedures performed for the management of VPS complications and the final outcome. Materials and Methods: This is a single-institution observational study that included children below 12 years of age who required VPS revisions during the study period. Results: During the study period of 10 years, n = 336 VPS catheters were implanted for the treatment of hydrocephalus in children. Forty (11.90%) children developed various VPS complications and required VPS revisions in the follow-up period. A total of n = 30 (8.92%) children ( n = 21 boys and n = 9 girls) were selected/recruited for the present study, and they required n = 34 revision procedures. The mean interval from VPS insertion to the diagnosis of the complication was 7.29 months. VPS complications that required revisions occurred in the following order of frequency: (1) VPS catheter, cerebrospinal fluid (CSF) or shunt tract infection n = 8 (2.38%); (2) malfunction of distal VPS catheter n = 7 (2.08%); (3) coiling of distal VPS catheter at abdominal area n = 6 (1.78%); (4) extrusion of VPS catheter n = 5 (1.48%); (5) CSF leak from abdominal wound site/umbilicus n = 4 (1.19%); (6) malfunction of ventricular catheter n = 3 (0.89%) and (7) CSF pseudocyst peritoneal cavity n = 1 (0.29%). Surgical procedures were performed for the treatment of abovementioned complications in the following order of frequency: (1) revision of distal VPS catheter n = 14 (4.16%), (2) removal of entire VPS catheter ± external ventricular drainage (EVD) n = 7 (2.08%), (3) distal VPS catheter converted as EVD n = 6 (1.78%), (4) revision of proximal VPS catheter n = 3 (0.89%), (5) revision of entire VPS catheter n = 3 (0.89%) and (6) CSF pseudocyst excision n = 1 (0.29%). This study also documented n = 2 (6.6%) deaths during the post-operative period. Conclusion: VPS insertion done for the treatment of hydrocephalus in infants and children was associated with various complications. Seventy per cent of the complications occurred within the first 6 months after the VPS insertion. Two-thirds of the complications were related to the distal VPS catheter.

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“…The most common classification system used in patients with TBM and hydrocephalus is Vellore grading system which was introduced for the first time in 1991 and later modified in 1998 [48,49]. This system classifies TBM in four grades, grade I representing the patient with GCS 15 points, and grade IV representing the patient in a deep coma (Table 1).…”

Section: Treatment Of Hydrocephalus In Tbmmentioning

confidence: 99%

“…The principle of surgical treatment of hydrocephalus is to divert the CSF flow. The main surgical options include bedside external ventricular shunt, ventriculoperitoneal shunt or endoscopic third ventriculostomy [7,48].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Hydrocephalus in Tuberculous Meningitis

Caliman-Sturdza¹,

Cucu²

2023

Frontiers in Hydrocephalus

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Hydrocephalus is a frequent complication of tuberculous meningitis. We present the incidence of hydrocephalus in patients diagnosed with tuberculosis of the nervous system, the therapeutic possibilities and the evolution of these patients. A consensus definition for tuberculous meningitis (TBM) stratified the cases as definite, probable and possible. In various studies, radiological investigations (CT, MRI) can be normal in the initial stages of the disease in approximately 30% of cases, but they do not exclude the possibility of a TBM. The most common radiological changes found in TBM are communicating hydrocephalus (up to 80% of cases), increased basal contrast (50%), cerebral tuberculomas (30%) and cerebral infarcts (10–40%). MRI has been shown to be more sensitive than a CT scan for diagnosed TBM. Communicating hydrocephalus is among the short-term complications of TBM (approximately 80% of cases), being more frequent than non-communicating ones. In these cases, the need to perform a ventriculo-peritoneal unit must be taken into account. Long-term complications are cognitive impairment, epilepsy, stroke, hydrocephalus, myelitis, damage to the hypothalamus or the pituitary gland manifested by obesity, growth disorders and diabetes insipidus. Sequels may occur frequently in TBM such as dementia, epilepsy, neurological deficits, behavioral disorders, blindness and deafness.

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The Outcome of Surgical Intervention (Ventriculoperitoneal Shunt and Endoscopic Third Ventriculostomy) in Patients With Hydrocephalus Secondary to Tuberculous Meningitis: A Systematic Review

Cited by 6 publications

References 23 publications

Factors associated with in-hospital mortality in HIV-infected children treated for tuberculous meningitis hydrocephalus

Factors associated with in-hospital mortality in HIV-infected children treated for tuberculous meningitis hydrocephalus

Management of Ventriculoperitoneal Shunt Complications in Children

Hydrocephalus in Tuberculous Meningitis

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