Endoscopy for tuberculous hydrocephalus

Area of Science:

• Neurosurgery
• Infectious Diseases
• Pediatric Neurology

Background:

• The role of endoscopic procedures in managing infectious hydrocephalus remains uncertain.
• Tuberculous hydrocephalus serves as a relevant model due to its complex pathophysiology and treatment challenges.

Purpose of the Study:

• To evaluate the efficacy and feasibility of endoscopic interventions in patients with hydrocephalus secondary to tuberculous meningitis.
• To assess the technical difficulties and outcomes associated with endoscopic procedures in this specific patient cohort.

Main Methods:

• Retrospective analysis of 24 endoscopic operations performed in patients with tuberculous meningitis.
• Specific procedures included endoscopic third ventriculostomy (ETV), fenestration, and biopsy of tuberculomas.

Main Results:

• Endoscopic third ventriculostomy (ETV) was attempted in 17 patients, with a success rate of 41% (7/17).
• Five ETV procedures failed, and five were not completed due to anatomical variations.
• Fenestration procedures had a 60% success rate (3/5); endoscopic biopsies did not yield bacteriological results.
• Endoscopic operations for tuberculous hydrocephalus were noted to be more technically demanding compared to other etiologies.

Conclusions:

• Endoscopic third ventriculostomy (ETV) is a technically viable option for tuberculous hydrocephalus.
• Optimal patient selection and experienced surgical teams are crucial for successful outcomes in these challenging cases.