Endoscopic third ventriculostomy in tubercular meningitis with hydrocephalus

Area of Science:

• Neurosurgery
• Infectious Diseases
• Pediatrics

Background:

• Endoscopic third ventriculostomy (ETV) is an emerging alternative for treating hydrocephalus secondary to tubercular meningitis (TBM).
• Hydrocephalus in TBM presents unique challenges requiring effective management strategies.

Purpose of the Study:

• To evaluate the efficacy and safety of ETV as a treatment for obstructive hydrocephalus in patients with TBM.
• To identify factors influencing the success of ETV in this patient population.

Main Methods:

• A prospective study involving 59 patients diagnosed with TBM and obstructive hydrocephalus.
• Preoperative confirmation of hydrocephalus using CT and/or MRI scans.
• ETV performed using standard techniques or water jet dissection.

Main Results:

• ETV demonstrated clinical improvement in 58% of patients; combined with a lumbar peritoneal shunt, improvement reached 80%.
• Factors such as malnutrition, complex hydrocephalus, and cisternal exudates were associated with poorer outcomes.
• Early recovery was observed in 81% of patients, with no operative deaths. Radiological recovery was 52% at 3 weeks.

Conclusions:

• ETV is a safe and effective neurosurgical procedure for TBM-related hydrocephalus.
• Complex hydrocephalus and cerebral infarcts are significant barriers to successful ETV outcomes.
• Patient grade and absence of complicating factors predict better ETV results.