Management of post-tubercular hydrocephalus.

Area of Science:

• Neurosurgery
• Infectious Diseases
• Neurology

Background:

• Tubercular meningitis frequently leads to hydrocephalus, a difficult complication.
• Current treatment protocols lack consensus.
• Hydrocephalus management in this context presents significant challenges and potential complications.

Purpose of the Study:

• To review literature and formulate treatment guidelines for hydrocephalus secondary to tubercular meningitis.
• To provide a treatment algorithm for protocol-based management.

Main Methods:

• Literature review of management options for tubercular hydrocephalus.
• Formulation of treatment guidelines based on literature and clinical experience.
• Development of a treatment algorithm considering patient condition, hydrocephalus type, and resource availability.

Main Results:

• Management options include conservative medical therapy, ventriculoperitoneal (VP) shunt, and endoscopic third ventriculostomy (ETV).
• VP shunt is suitable for most patients.
• ETV is a viable option for selected patients with available endoscopic facilities and expertise.

Conclusions:

• Tubercular basal meningitis management is primarily medical, with neurosurgery indicated for hydrocephalus.
• Hydrocephalus management in tubercular meningitis is challenging.
• A proposed algorithm aids clinicians in objective patient assessment and protocol-based decision-making.