Role of endoscopy in recalcitrant intraventricular tuberculoma-innovative novel treatment adjunct
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Published on: May 23, 2025
Suhas Udayakumaran1, Prakash Nair1, Anil Kumar2
1a Division of Pediatric Neurosurgery, Department of Neurosurgery , Amrita Institute of Medical Sciences and Research Centre , Kochi , India.
Introduction:
Intraventricular tuberculomas are rare entities. To the best of our knowledge, only 14 cases have been reported in English literature. Medical management of cerebral tuberculomas is well accepted. Intraventricular tuberculomas may be recalcitrant for unclear reasons. An effective management protocol for this entity is unclear. To the best of our knowledge, the definitive indication, timing, and possible role of surgery in these lesions have not been discussed in literature.
Materials And Methods:
A 27-year-old nursing professional who was undergoing treatment for miliary tuberculosis at another center presented to us in 2008 with right hemiparesis, deteriorating vision, and progressive decline in consciousness. In addition to antituberculous therapy (ATT), she underwent multiple CSF diversion procedures for the obstructive hydrocephalus secondary to a recalcitrant third ventricular tuberculoma. Finally, she underwent endoscopic decompression of the lesion with a very good clinical response at 1-year follow-up.
Discussion:
We discuss a patient with recalcitrant intraventricular tuberculoma managed using neuroendoscopy along with the standard antituberculous therapy. We also discuss in detail the technique we utilized for endoscopic management of this lesion.
Conclusion:
Being a rare entity, a consensus for management of these lesions is not possible, but we have demonstrated that neuroendoscopic management of these rare entities is an option giving the advantage of definitive diagnosis when required, hastening the resolution, and clearing the CSF pathway.
Insights
Intraventricular tuberculomas are rare, often resistant to standard treatment. Neuroendoscopic decompression, combined with antituberculous therapy, offers a viable management option for these challenging lesions.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Neurology
Background:
- Intraventricular tuberculomas are exceptionally rare, with limited reported cases.
- Standard medical management for cerebral tuberculomas is established, but intraventricular forms can be treatment-resistant.
- Optimal treatment protocols and the role of surgery for intraventricular tuberculomas remain unclear.
Purpose of the Study:
- To present a case of recalcitrant intraventricular tuberculoma.
- To discuss the neuroendoscopic management of this rare entity.
- To highlight the potential benefits of endoscopic intervention in select cases.
Main Methods:
- A 27-year-old female with miliary tuberculosis presented with obstructive hydrocephalus due to a third ventricular tuberculoma.
- The patient received antituberculous therapy (ATT) and underwent CSF diversion procedures.
- Endoscopic decompression of the tuberculoma was performed.
Main Results:
- The patient experienced a significant clinical improvement following endoscopic decompression.
- A 1-year follow-up demonstrated a very good clinical response.
- Neuroendoscopy facilitated definitive diagnosis and cleared the CSF pathway.
Conclusions:
- Neuroendoscopic management is a feasible option for recalcitrant intraventricular tuberculomas.
- This approach can aid in diagnosis, expedite resolution, and relieve obstructive hydrocephalus.
- While consensus is lacking due to rarity, endoscopic decompression offers advantages in managing these challenging lesions.
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