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Updated: Aug 18, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Role of shunt surgery in pediatric tubercular meningitis with hydrocephalus
Deepak Agrawal1, Aditya Gupta, V S Mehta
1Department of Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110 029, India.
Insights
Ventriculoperitoneal shunting is recommended for children with hydrocephalus due to tubercular meningitis (TBMH) stages II and III, offering good outcomes. For stage IV, external ventricular drainage followed by shunting is most effective.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Neurology
Background:
- Hydrocephalus is a common complication of tubercular meningitis (TBMH) in children.
- Ventriculoperitoneal shunting is a potential treatment for TBMH-associated hydrocephalus.
- Evaluating shunt indications and outcomes in pediatric TBMH is crucial.
Purpose of the Study:
- To assess the indications for ventriculoperitoneal shunting in pediatric TBMH with hydrocephalus.
- To analyze shunt-related complications and patient outcomes.
- To determine optimal management strategies based on disease severity.
Main Methods:
- Retrospective study of 37 children (<18 years) with TBMH and hydrocephalus from 1999-2001.
- Patients were classified by Palur stage (II, III, IV) and prior antitubercular therapy.
- Outcomes and complications were assessed at 3-month follow-up.
Main Results:
- Shunt complications occurred in 30% of children; 3 required multiple revisions.
- Good outcomes were observed in 43% of patients.
- Outcomes varied by stage: 62% good in stage II, 40% in stage III, and poor in all stage IV patients.
Conclusions:
- Ventriculoperitoneal shunting is recommended for pediatric TBMH stages II and III.
- External ventricular drainage followed by shunting is the preferred approach for stage IV TBMH.
- Management should be tailored to the specific stage of TBMH and hydrocephalus.
Abstract:
This study was designed to evaluate the indications for ventriculoperitoneal shunting in cases of children with tubercular meningitis, presenting with hydrocephalus. Thirty seven children (less than 18 years of age) of tubercular meningitis with hydrocephalus (TBMH) who underwent ventriculoperitoneal shunting over a three year period (1999 to 2001) were included in the study. Sixteen (43%) children were Palur stage II, 15 (40%) stage III, and 6 (16%) stage IV. Fifteen (40%) children had received antitubercular therapy for less than 4 months and 17 (46%) received therapy for more than 4 months prior to presentation. Five (14%) children had not previously received antitubercular therapy. Shunt related complications occurred in 11 (30%) children and 3 children had undergone revision of the shunt multiple times. Good outcome was seen in 16 (43%) children. Thirteen (35%) had moderate disability and 6 (16%) had severe disability at 3 months of follow up. 62% (n =10) children in grade II had a good outcome compared to 40% (n = 6) in grade III. All six children in grade IV had a poor outcome. 2 children, both having multiple infarcts, died and the remaining 4 were left with severe disability. We recommend shunt placement in all children of grade II and III TBMH as this policy has yielded the best results. For grade IV children external ventricular drainage, followed by shunting if improvement occurs remains the most cost-effective procedure.
