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Management of hydrocephalus in patients with tuberculous meningitis

Vedantam Rajshekhar1

  • 1Department of Neurological Sciences, Christian Medical College, Vellore, India. rajshekhar@cmcvellore.ac.in

Neurology India
|September 23, 2009
PubMed

Insights

Hydrocephalus affects up to 85% of children with tuberculous meningitis (TBM). Management varies from medical therapy for good grades to surgical interventions like shunts or ETV for severe or obstructive cases, with significant associated risks.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pediatrics

Background:

  • Hydrocephalus is a frequent complication of tuberculous meningitis (TBM), particularly severe in children.
  • It presents as communicating or obstructive types, with communicating hydrocephalus being more common.
  • The Vellore grading system categorizes TBM and hydrocephalus severity, aiding clinical management.

Purpose of the Study:

  • To review the management strategies for hydrocephalus in tuberculous meningitis.
  • To analyze the efficacy and complications of surgical interventions.
  • To discuss the prognostic implications of hydrocephalus severity and treatment outcomes.

Main Methods:

  • Literature review of hydrocephalus management in tuberculous meningitis.
  • Analysis of medical and surgical treatment options.
  • Evaluation of complication rates and long-term mortality associated with different interventions.

Main Results:

  • Medical management (dehydrating agents, steroids) is suitable for good grades and communicating hydrocephalus.
  • Surgical options include ventriculo-peritoneal shunts and endoscopic third ventriculostomy (ETV).
  • Shunt surgery in TBM patients has high complication rates (obstruction, infection), necessitating revisions. ETV success is variable and not recommended in acute stages. Mortality rates vary significantly based on pre-operative sensorium and disease grade.

Conclusions:

  • Surgical intervention for hydrocephalus in TBM is complex, with significant risks and variable outcomes.
  • The utility of aggressive surgical management, particularly in severe cases (Vellore grade IV), is questionable due to high mortality.
  • Further research into optimal management strategies for TBM-associated hydrocephalus is warranted.

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