Dural biopsy-- an important prognostic indicator in tuberculous meningitis with hydrocephalus following shunt surgery

This study has been carried out in the department of paediatric surgery, Medical College and Hospital, Kolkata, with an aim to prognosticate the postoperative outcome of the patients of hydrocephalus following tuberculous meningitis after placement of ventriculoperitoneal shunt. Amongst various variables, clinical grading at the time of operation was thought to be an important predictor for outcome following ventriculoperitoneal shunt, but unfortunately remained unpredictable in final outcome in many patients. In the present study, pre-operatively the patients were first graded clinically. In an attempt to prognosticate these patients, a tiny piece of dura was taken during placement of the ventriculoperitoneal shunt from the site of insertion of the shunt and the sample was sent for histopathological examination. Histopathological findings were classified as healthy dura and unhealthy dura (with cellular infiltration, fibrosis and calcification) and correlated with the postoperative clinical outcome. Out of total 28 patients treated from June, 2001 to September, 2005, 19 patients showed healthy dura and 9 patients showed unhealthy dura. Results in this study reveal that postoperative recovery and long term outcome of the patients with healthy dura are better and that of unhealthy dura are poor irrespective of pre-operative clinical grading. Fourteen (74%) out of 19 patients who had healthy dura improved satisfactorily whereas only 1 out of 9 patients who had unhealthy dura improved satisfactorily.