Large Tuberculous Mass Lesions Involving the Brain: Outcomes and Management

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Central nervous system tuberculosis (CNS TB) can manifest as large tuberculous mass lesions (LTML), posing management challenges.
• Optimal therapeutic strategies for LTML, including tuberculomas and tubercular abscesses ≥3 cm, require further elucidation.

Purpose of the Study:

• To evaluate the outcomes of different management strategies for patients with large tuberculous mass lesions (LTML) of the central nervous system.
• To assess the impact of antituberculous therapy (ATT) alone versus ATT combined with steroids or surgical intervention on patient functional independence.

Main Methods:

• A retrospective, single-center observational study included 46 patients diagnosed with LTML between January 2010 and February 2023.
• Outcomes were assessed using the modified Rankin Scale (mRS) at 6-month follow-up, focusing on independence in daily living activities.
• Treatment groups included ATT alone, ATT with steroids, ATT with surgery, and ATT with steroids and surgery.

Main Results:

• Favorable outcomes were observed in 76.9% with ATT alone, 62.5% with ATT and steroids, 87.5% with ATT and surgery, and 66.9% with ATT, steroids, and surgery.
• The median mRS improved from 2 at baseline to 1 at 6-month follow-up across all patients.
• Adding steroids or surgical intervention to ATT did not yield statistically significant improvements in primary outcomes (P=0.637).

Conclusions:

• Antituberculous therapy (ATT) alone appears to be a viable option for managing central nervous system large tuberculous mass lesions (LTML).
• Current evidence does not strongly support the routine addition of steroids or surgical intervention to ATT for improving functional outcomes in LTML.
• Larger, prospective studies are warranted to definitively establish the optimal management paradigm for CNS LTML.