Treatment of intraspinal tuberculoma

Neurological manifestations in spinal tuberculosis often occur secondary to vertebral involvement. However, tuberculoma of the spinal cord or extradural granuloma without radiological evidence of vertebral involvement may be responsible for neurological complications. We report 22 patients with intraspinal tuberculoma (19 extradural, three intramedullary) ranging in age from 17 to 70 years. Three patients had a history of paraplegia of acute onset (within 12 hours of the appearance of neural deficit). Only four patients had spinal tenderness, and bone involvement could be seen on plain radiographs in only three patients. Extradural tubercular granuloma without vertebral involvement is uncommon. Of the 15 extradural tuberculoma patients who had a CT scan and/or MRI, only five had no osseous involvement. Laminectomy and surgical decompression was performed in all 19 patients with extradural granuloma. Thirteen patients showed complete neural recovery within 2 years. Of the three patients with intramedullary involvement, one underwent myelotomy and decompression and died within 2 months of surgery. The other two patients were treated nonoperatively with antitubercular therapy and showed complete neural recovery. All patients received antitubercular therapy for a minimum of 1 year. Intraspinal tubercular granuloma should be considered in the differential diagnosis when a case of spinal tumor syndrome is encountered in an endemic zone of tuberculosis.