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LETTER TO THE EDITOR
Year : 2012  |  Volume : 15  |  Issue : 3  |  Page : 231
 

Management of hydrocephalus in tuberculous meningitis


Department of Neurosurgery, 235, Academic Block, PGIMER and Dr. RML Hospital, New Delhi, India

Date of Web Publication14-Aug-2012

Correspondence Address:
Suryanarayanan Bhaskar
Department of Neurosurgery, 235, Academic Block, PGIMER and Dr. RML Hospital, New Delhi- 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.99736

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How to cite this article:
Bhaskar S. Management of hydrocephalus in tuberculous meningitis. Ann Indian Acad Neurol 2012;15:231

How to cite this URL:
Bhaskar S. Management of hydrocephalus in tuberculous meningitis. Ann Indian Acad Neurol [serial online] 2012 [cited 2019 Oct 23];15:231. Available from: http://www.annalsofian.org/text.asp?2012/15/3/231/99736


Sir,

I read with interest the articles regarding the guidelines of various neurological disorders (Annals of Indian Academy of Neurology Volume 14, Suppl 1, July 2011). It is very informative and something which was very much needed, in terms of guidelines for treating neurological disorders in the Indian scenario. I have a comment regarding the article on cerebral malaria and bacterial meningitis (Mishra UK et al). The role of surgery in the management of hydrocephalus has not been correctly mentioned. It is reported that ventriculoperitoneal shunt is the treatment of choice. This is not the case now. These patients can be candidates for endoscopic third ventriculostomy (ETV). In a retrospective analysis of 203 patients with a follow up of up to 22.6 years, the overall probability of success (failure defined as shunt insertion, ETV revision or death) was 89%. [1] The only statistically significant factor associated with long-term reliability was age. Studies done in hydrocephalus due to tuberculous meningitis, which is a major cause in our country, ETV has shown success rates ranging from 40-60%. [2],[3],[4] The ventriculoperitoneal shunt leaves an implant inside the body which has its own set of complications like infection, blockage, extrusion which cause significant morbidity and occasional mortality. Other than these issues shunting an isolated fluid space creates a pressure differential across the obstruction which is not physiological. Endoscopic techniques, on the other hand are more physiological in creation of normal cerebrospinal fluid (CSF) flow or bypassing an obstruction. A sincere attempt to establish CSF pathway by an endoscopic method should be done before placing a shunt. I agree that in deeply comatose patients (TBM grade III and IV) a trial of CSF drainage would help n deciding the candidates for surgery. [5]

The management of hydrocephalus in tuberculous meningitis has undergone a change since the advent of neuroendoscopy. Ventriculoperitoneal shunt is no longer the treatment of choice in all cases. These patients should undergo an endoscopic procedure, which has shown promising results and more importantly saves these patients of the shunt related complications.

 
   References Top

1.Kadrian D, van Gelder J, Florida D, Jones R, Vonau M, Teo C, et al. Long term reliability of endoscopic third ventriculostomy. Neurosurgery 2005;56:1271-8.  Back to cited text no. 1
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2.Singh D, Sachdev V, Singh AK, Sinha S. Endoscopic third ventriculostomy in post-tubercular meningitic hydrocephalus: A preliminary report. Minim Invasive Neurosurg 2005;48:47-52.  Back to cited text no. 2
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3.Jha DK, Mishra V, Choudhary A, Khatri P, Tiwari R, Sural A, et al. Factors affecting the outcome of neuroendoscopy in patients with tuberculous meningitis hydrocephalus: A preliminary study. Surg Neurol 2007;68:35-41 discussion 41-2.  Back to cited text no. 3
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4.Chugh A, Husain M, Gupta RK, Ojha BK, Chandra A, Rastogi M. Surgical outcome of TBM hydrocephalus treated by endoscopic third ventriculostomy: Prognostic factors & post operative imaging for functional assessment of ventriculostomy. J Neurosurg Pediatr 2009;3:371-7.  Back to cited text no. 4
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5.Rajashekar V. Management of hydrocephalus in patients with tuberculous meningitis. Neurol India 2009;57:368-74.  Back to cited text no. 5
    




 

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