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Ventriculoperitoneal shunting in childhood tuberculous meningitis
D Lamprecht1, J Schoeman, P Donald
1Department Neurosurgery, University of Stellenbosch Medical School, Parow, Republic of South Africa. lamprecht@gem.co.za
Insights
Tuberculous meningitis with hydrocephalus in children often requires treatment. Ventriculoperitoneal shunting (VPS) was used in 30% of cases, with significant complications noted, but remains crucial for non-communicating hydrocephalus.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Hydrocephalus is a frequent complication of tuberculous meningitis (TBM) in pediatric patients.
- Tuberculous meningitis with hydrocephalus (TBMH) presents significant management challenges.
Purpose of the Study:
- To evaluate the outcomes and complications of ventriculoperitoneal shunting (VPS) in children with TBMH.
- To identify factors influencing the need for VPS and patient outcomes.
Main Methods:
- Retrospective review of 217 pediatric patients with stage II and III TBMH.
- Analysis of VPS indications, including non-communicating vs. communicating hydrocephalus.
- Assessment of patient outcomes and complication rates over a 6-month follow-up period.
Main Results:
- Only 29.9% of patients required VPS; 58.5% of shunted cases had non-communicating hydrocephalus.
- Good outcome or moderate disability occurred in 55.4% of shunted patients; 12.3% mortality.
- High complication rate (32.3%) in shunted patients, with shunt infection and obstruction each at 13.5%.
Conclusions:
- TBMH is a severe condition with high VPS complication rates.
- Identifying patients who can avoid shunting can reduce costs and complications.
- Early VPS is indicated for non-communicating hydrocephalus in TBMH.
Abstract:
Hydrocephalus is a common complication of tuberculous meningitis (TBM) in children. In this study, 217 patients with stage II and III TBM and hydrocephalus (TBMH) were reviewed. Ventriculoperitoneal shunting (VPS) was performed in the acute stage if the hydrocephalus was non-communicating or following failed medical therapy if the hydrocephalus was communicating. Following this protocol only 65 of 217 (29.9%) patients eventually required VPS. Non-communicating hydrocephalus was present in 38 of 65 (58.5%) and communicating hydrocephalus in 27 of 65 (41.5%) of the shunted cases. These 65 cases were followed for 6 months and their outcome assessed. Good outcome or moderate disability was seen in 55.4% and 12.3% died. Different factors relating to outcome are discussed. The shunted patients in this study had a high complication rate of 32.3%, with shunt infection and shunt obstruction each occurring in 9 of 65 (13.5%) of cases. TBM complicated by hydrocephalus remains a devastating condition and VPS in these patients has a high complication rate. Identifying those patients who may be managed without shunting will save costs and reduce complications, however early VPS in patients with non-communicating hydrocephalus is still indicated.