Large Tuberculous Mass Lesions Involving the Brain: Outcomes and Management

The optimal management of large tuberculous mass lesions (LTML) involving the central nervous system remains unclear. We conducted a single-center, retrospective, observational study that assessed the outcomes of patients with LTML from January 2010 to February 2023. An LTML was defined as a tuberculoma or tubercular abscess exceeding or equal to 3 cm. The primary outcome was independence in activities of daily living, as assessed by the modified Rankin Scale (mRS) at a follow-up of 6 months. Forty-six patients were identified during the study period. Their mean age was 27.6 ± 12 years, the median duration of antituberculous therapy (ATT) was 18 months, and the median duration of follow-up was 20 months (interquartile range 15.7-40). The favorable outcomes were 76.9% (10/13) for ATT alone, 62.5% (10/16) for ATT with steroids, 87.5% (7/8) for ATT with surgery, and 66.9% (6/9) for ATT, steroids, and surgery. The median mRS at baseline in the study was 2 (1-3), and at the 6 month follow-up, it was 1 (0-2). Adding steroids or surgical intervention to ATT did not significantly improve primary outcomes (P = 0.637). Further large-scale studies are necessary to confirm these preliminary observations.