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Published on: October 14, 2022
Modified external ventricular drainage in pediatric tuberculous meningitis: is it possible to avoid
Jian Lin1, Nu Zhang, Hang-song Sheng
1Department of Neurosurgery, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, PR China.
Insights
A modified external ventricular drainage may help children with tuberculous meningitis avoid ventriculoperitoneal shunts. This approach showed safe effects and improved outcomes in a small study.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Neurology
Background:
- Ventriculoperitoneal shunting is standard for hydrocephalus in pediatric tuberculous meningitis.
- Shunts carry risks of complications and potential long-term psychological effects on children.
Purpose of the Study:
- To explore alternative cerebrospinal fluid (CSF) diversion methods to avoid ventriculoperitoneal shunting.
- To evaluate the efficacy and safety of a modified external ventricular drainage (EVD) in children with tuberculous meningitis and hydrocephalus.
Main Methods:
- A study involving 6 pediatric cases with tuberculous meningitis and hydrocephalus.
- Utilized a modified external drainage system from the ventricle to the subcutaneous abdomen.
- Assessed outcomes over 6-9 months, focusing on radiological improvements and need for shunting.
Main Results:
- External drainage tubes were removed in 4 cases after 4-6 months.
- Two patients eventually required ventriculoperitoneal shunts.
- All patients normalized CSF protein and cell counts, with improved ventricular morphology and no secondary intracranial infections.
Conclusions:
- The modified ventricular drainage device demonstrated satisfactory outcomes and a favorable safety profile.
- This approach may offer a viable alternative to ventriculoperitoneal shunting for select pediatric patients.
Objective:
Ventriculoperitoneal shunting is the current mainstay of treatment for children with tuberculous meningitis with hydrocephalus. However, ventriculoperitoneal shunting is highly associated with complications, and more importantly, long-term, indwelling shunt devices may adversely affect children's spirits and psychological health. Therefore, there is clearly a need to explore methods of CSF diversion to avoid ventriculoperitoneal shunting.
Methods:
We studied 6 cases of children with tuberculous meningitis with hydrocephalus in whom external drainage from the ventricle to the subcutaneous abdomen was adopted. Outcomes were assessed over a 6- to 9-month follow-up period based on improvements in radiological features, such as ventricular morphology, as well as the need for ventriculoperitoneal shunting and any complications.
Results:
The drainage tubes were removed in 4 cases 4-6 months after the modified external ventricular drainage surgery, and 2 patients went on to receive a ventriculoperitoneal shunt. All patients' CSF protein and cell counts returned to normal, and imaging showed improved ventricular morphology and no intracranial secondary infection.
Conclusion:
In our preliminary study, the modified ventricular drainage device can produce satisfactory outcomes and relatively safe effects and may help some patients to avoid ventriculoperitoneal shunt placement.