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Management of craniovertebral junction tuberculosis.
Dhaval Shukla1, Sanjay Mongia, B Indira Devi
1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
Surgical Neurology
|February 1, 2005
Summary
Tuberculosis of the craniovertebral junction (CVJ) is rare but treatable. Effective management combines antituberculous drugs with surgical options like transoral decompression and fusion for instability.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Spinal Surgery
Background:
- Craniovertebral junction (CVJ) tuberculosis is an uncommon condition with potentially increasing incidence.
- Diagnosis can be challenging despite advanced imaging like MRI.
- The transoral approach offers safe and effective access for biopsy and decompression.
Purpose of the Study:
- To review outcomes of 24 patients with craniovertebral junction tuberculosis.
- To evaluate the effectiveness of conservative and surgical management strategies.
- To assess the role of antituberculous drug therapy.
Main Methods:
- Retrospective review of 24 confirmed cases of CVJ tuberculosis.
- Patients received 18 months of antituberculous drug treatment.
- Management included conservative care, transoral biopsy, transoral decompression with posterior fusion, or posterior fusion alone.
Main Results:
- All 24 patients showed improvement, with a mean Nurick grading improvement of 1.71.
- Histopathology revealed varied findings including abscess, granulation tissue, and chronic osteomyelitis.
- Positive outcomes were observed even in patients with pre-existing spinal cord signal changes on MRI.
Conclusions:
- CVJ tuberculosis, though rare, has a good treatment prognosis.
- Antituberculous drug therapy is the cornerstone of management.
- Surgical interventions like transoral decompression and fusion are guided by the presence and persistence of atlantoaxial instability.