Skip to main content

Advertisement

SpringerLink
Log in

Role of neuroendoscopy in the management of patients with tuberculous meningitis hydrocephalus

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

The role of neuroendoscopy in patients of tuberculous meningitis with hydrocephalus (TBMH) is not yet established. We present details of endoscopic morphology, and analyze outcome of Neuroendoscopy performed in 28 patients (15 males and 13 females, average age 23 years) of TBMH in last 2.5 years. Endoscopic procedures performed included endoscopic third ventriculostomy (ETV) alone (n=19), ETV with monroplasty (n=2), and septostomy (n=2), ETV with decompression/biopsy of tuberculoma (n=2) and with abscess drainage (n=1). Outcome was assessed on the basis of clinico-radiological improvement, need for external shunt and complications. Outcome was satisfactory in 14 (50%), acceptable in five (18%) and unsatisfactory in nine (32%) patients. Overall, 19 (68%) patients benefited from endoscopic intervention. Cerebrospinal fluid (CSF) leak (n=2) and per-operative bleeding (n=1) were the only complications encountered. Endoscopy appears to be helpful in a considerable number of patients with TBMH, and should be considered as the first surgical option for CSF diversion surgery in these patients. External shunt should be reserved for those who fail the endoscopic CSF diversion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

References

  1. Aoki N (1990) Lumboperitoneal shunt: clinical applications, complications, and comparison with ventriculoperitoneal shunt. Neurosurgery 26(6):998–1004

    Article  CAS  PubMed  Google Scholar 

  2. Bhagwati SN (1971) Ventriculoatrial shunt in tuberculous meningitis with hydrocephalus. J Neurosurg 35:309–313

    Google Scholar 

  3. Bhargava S, Gupta AK, Tandon PN (1982) Tuberculous meningitis—a CT study. Br J Radiol 55(651):189–196

    CAS  PubMed  Google Scholar 

  4. Bullock MMR, van Dellen JR (1982) The role of cerebrospinal fluid shunting in tuberculous meningitis. Surg Neurol 18:247–274

    Google Scholar 

  5. Chumas PD, Kulkarni AV, Drake JM, Hoffman HJ, Humphreys RP, Rutka JT (1993) Lumboperitoneal shunting: a retrospective study in the pediatric population. Neurosurgery 32(3):376–383

    Google Scholar 

  6. Cinalli G (1999) Alternatives to shunting. Childs Nerv Syst 15:718–731

    Article  CAS  PubMed  Google Scholar 

  7. Cinalli G, Sainte-Rose C, Chumas P, Zerah M, Brunelle F, Lot G, Pierre-Kahn A, Renier D (1999) Failure of third ventriculostomy in the treatment of aqueductal stenosis in children. J Neurosurg 90(3):448–454

    CAS  PubMed  Google Scholar 

  8. Cinalli G, Salazar C, Mallucci C, Yada JZ, Zerah M, Sainte-Rose C (1998) The role of endoscopic third ventriculostomy in the management of shunt malfunction: clinical study. Neurosurgery 43(6):1323–1329

    Article  CAS  PubMed  Google Scholar 

  9. Dastur DK, Lalitha VS, Udani PM, Parekh UC (1970) The brain and meninges in tuberculous meningitis. Gross pathology in 100 cases and pathogenesis. Neurol India 18:86–100

    CAS  PubMed  Google Scholar 

  10. Elad Y, Nelson PJ, Meier DE (1998) Jumping to the wrong conclusion. N Engl J Med 339:1382–1387

    Google Scholar 

  11. Fallon RJ, Kennedy DH (1981) Treatment and prognosis of in tuberculous meningitis. J Infect (Suppl 1):39–44

  12. Figaji AA, Fieggen AG, Peter JC (2003) Endoscopic third ventriculostomy in tuberculous meningitis. Childs Nerv Syst 19:217–225

    Article  CAS  PubMed  Google Scholar 

  13. Fukuhara T, Vorster SJ, Luciano MG (2000) Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurgery 46:1100–1109

    Article  CAS  PubMed  Google Scholar 

  14. Gelabert M, Castro-Gago M (1988) Hydrocephalus and tuberculous meningitis in children. Childs Nerv Syst 4:268–270

    CAS  PubMed  Google Scholar 

  15. Greitz D (2004) Radiological assessment of hydrocephalus: new theories and implications for therapy. Neurosurg Rev 27(3):145–65

    PubMed  Google Scholar 

  16. Greitz D, Greitz T, Hindmarsh T (1997) A new view on the CSF-circulation with the potential for pharmacological treatment of childhood hydrocephalus. Acta Paediatr 86(2):125–132

    CAS  PubMed  Google Scholar 

  17. Greitz D, Hannerz J (1996) A proposed model of cerebrospinal fluid circulation: observations with radionuclide cisternography. Am J Neuroradiol 17:431–438

    CAS  PubMed  Google Scholar 

  18. Gupta RK, Gupta S, Singh D, Sharma B, Kohli A, Gujral RB (1994) MR imaging and angiography in tuberculous meningitis. Neuroradiology 36:87–92

    Article  CAS  PubMed  Google Scholar 

  19. Gupta RK, Kathuria MK, Pradhan S (1999) Magnetization transfer MR imaging in CNS tuberculosis. Am J Neuroradiol 20:867–875

    CAS  PubMed  Google Scholar 

  20. Hirsch JF, Hirsch E, Sainte-Rose C, Renier D, Pierre-Kahn A (1986) Etiology and treatment. J Neurosurg Sci 30:29–39

    CAS  PubMed  Google Scholar 

  21. Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A (1999) Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 44(4):795–806

    Article  CAS  PubMed  Google Scholar 

  22. Hosoglu S, Ayaz C, Geyik MF, Kokoglu MF, Ceviz A (1998) Tuberculours meningitis in adults: an eleven-year review. Int J Tuberc Lung Dis 2:553–557

    CAS  PubMed  Google Scholar 

  23. Husain M, Jha D, Thaman D, Husain N, Gupta RK (2004) Ventriculostomy in a tumor involving the third ventricular floor. Neurosurg Rev 27(1):70–72

    Article  PubMed  Google Scholar 

  24. Husain M, Jha D, Vatsal DK, Thaman D, Gupta A, Husain N, Gupta RK (2003) Neuroendoscopic surgery- experience and outcome analysis of 102 consecutive procedures in a busy neurosurgical centre of India. Acta Neurochir (Wien) 145(5):369–376

    CAS  Google Scholar 

  25. Jinkins JR, Gupta RK, Chang KH, Rodriguez-Carbajal J (1995) MR imaging of central nervous system tuberculosis. Radiol Clin N Am 33(4):771–786

    CAS  PubMed  Google Scholar 

  26. Jones RFC, Teo C, Steining WA, Kwok BCT (1992) Neuroendoscopic third ventriculostomy. In: Manwaring KH, Crone KR (eds) Neuroendoscopy, vol 1. Mary Ann Liebert Publishers, Larchmont, pp 63–77

    Google Scholar 

  27. Jones RF, Kwok BC, Steining WA, Vonau M (1994) The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invasive Neurosurg 37:28–36

    CAS  PubMed  Google Scholar 

  28. Jones RF, Kwok BC, Steining WA, Vonau M (1994) Neuroendoscopic third ventriculostomy: a practical alternative to extracranial shunts in non-communicating hydrocephalus. Acta Neurochir Suppl (Wien) 61:79–83

    CAS  Google Scholar 

  29. Joosten AAJ, van der Valk PDLPM, Geelen JAG, Severin WPJ, Jansen Steur ENH (2000) Tubercular meningitis: pitfalls in diagnosis. Acta Neurol Scand 102:388–394

    Google Scholar 

  30. Kamra P, Azad R, Prasad KN, Jha S, Pradhan S, Gupta RK (2004) Infectious meningitis: prospective evaluation with magnetization transfer MRI. Br J Radiol 77(917):387–394

    Article  CAS  PubMed  Google Scholar 

  31. Kang S (2000) Efficacy of lumbo-peritoneal versus ventriculo-peritoneal shunting for management of chronic hydrocephalus following aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 142(1):45–49

    Article  CAS  Google Scholar 

  32. Kehler U, Gliemroth J, Knopp U, Arnold H (1998) The role of third ventriculostomy in previously shunted hydrocephalus. In: Hellwig D, Bauer BL (eds) Minimally invasive techniques for neurosurgery. Springer, Berlin Heidelberg New York, pp 77–80

    Google Scholar 

  33. Kemaloglu S, Özkan Ü, Bukte Y, Ceviz A, Özates M (2002) Timing of shunt surgery in childhood tuberculous meningitis with hydrocephalus. Pediatr Neurosurg 37:194–198

    Article  PubMed  Google Scholar 

  34. Kristensen B, Malm J, Markgren P, Ekstedt J (1992) CSF hydrodynamics in superior sagittal sinus thrombosis. J Neurol Neurosurg Psychiatry 55(4):287–293

    CAS  PubMed  Google Scholar 

  35. Kumar R, Singh SN, Kohli N (1999) A diagnostic rule for tuberculous meningitis. Arch Dis Child 81:221–224

    CAS  PubMed  Google Scholar 

  36. Lamprecht D, Schoeman J, Donald P, Hartzenberg H (2001) Ventriculoperitoneal shunting in childhood tuberculous meningitis. Br J Neurosurg 15:119–125

    Article  CAS  PubMed  Google Scholar 

  37. Mathew JM, Rajshekhar V, Chandy MJ (1998) Shunt surgery in poor grade patients with tuberculous meningitis and hydrocephalus: effects of response to external ventricular drainage and other variables on long term outcome. J Neurol Neurosurg Psychiatry 65:115–118

    CAS  PubMed  Google Scholar 

  38. Mishra UK, Kalita J, Roy AK, Mandal SK, Srivastava M (2000) Role of clinical, radiological, and neurophysiological changes in predicting the outcome of tuberculous meningitis: a multivariable analysis. J Neurol Neurosurg Psychiatry 68:300–303

    Article  PubMed  Google Scholar 

  39. Murray HW, Brandstetter RD, Lavyne MH (1981) Ventriculoatrial shunting for hydrocephalus complicating tuberculous meningitis. Am J Med 70:895–898

    Google Scholar 

  40. Palur R, Rajshekhar V, Chandy MJ, Joseph T, Abraham J (1991) Shunt surgery for hydrocephalus in tuberculous meningitis: a long term follow-up study. J Neurosurg 74:64–69

    CAS  PubMed  Google Scholar 

  41. Bhadelia RA, Bogdan AR, Wolpert SM (1995) Analysis of cerebrospinal fluid flow waveforms with gated phase-contrast MR velocity measurements. Am J Neuroradiol 16(2):389–400

    CAS  PubMed  Google Scholar 

  42. Sainte-Rose C (1992) Third ventriculostomy. In: Manwaring KH, Crone KR (eds) Neuroendoscopy, vol 1. Mary Ann Liebert Publishers, Larchmont, pp 47–62

    Google Scholar 

  43. Scarrow AM, Levy EI, Pascucci L, Albright AL (2000) Outcome analysis of endoscopic III ventriculostomy. Childs Nerv Syst 16(7):442–445

    Article  CAS  PubMed  Google Scholar 

  44. Schoeman JF, Van Zyl LE, Laubscher JA, Donald PR (1997) Effect of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis. Pediatrics 99(2):226–231

    Article  CAS  PubMed  Google Scholar 

  45. Schwartz TH, Yoon SS, Cutruzzola FW, Goodman RR (1996) Third ventriculostomy: post-operative ventricular size and outcome. Minim Invasive Neurosurg 39(4):122–129

    CAS  PubMed  Google Scholar 

  46. Siomin V, Cinalli G, Grotenhuis A, Golash A, Oi S, Kothbauer K, Weiner H, Roth J, Beni-Adani L, Pierre-Kahn A, Takahashi Y, Mallucci C, Abbott R, Wisoff J, Constantini C (2002) Endoscopic third ventriculostomy in patients after cerebrospinal fluid infection and/or hemorrhage. J Neurosurg 97:519–524

    PubMed  Google Scholar 

  47. Sufainov AA, Il’ina GP, Frolova EV (2001) Endoscopic ventriculocisternostomy in the treatment of complications of tuberculous meningoencephalitis in an infant. Probl Tuberk 1:48–51

    PubMed  Google Scholar 

  48. Tan EK, Chee MWI, Chan LI, Lee YL (1999) Culture positive tuberculous meningitis: clinical indications of poor prognosis. Clin Neurol Neurosurg 101:157–160

    Article  CAS  PubMed  Google Scholar 

  49. Thomas MD, Copra JS, Banerjee AK, Singh MS (1997) Tuberculous meningitis: a clinicopathological study. Neurol India 25:26–34

    Google Scholar 

  50. Udani PM, Parekh UC, Dastur DK (1971) Neurological and related syndromes in CNS tuberculosis: clinical features and pathogenesis. J Neurol Sci 14:341–357

    Article  CAS  PubMed  Google Scholar 

  51. Zumla A, Grange JM (1999) Doing something about tuberculosis. BMJ 318:956

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Manu Rastogi acknowledges the financial assistance of the council of Scientific and Industrial Research, New Delhi, India.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, King George’s Medical University, Lucknow, India

    Mazhar Husain, Deepak K. Jha & Manu Rastogi

  2. Department of Pathology, King George’s Medical University, Lucknow, India

    Nuzhat Husain

  3. Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Rakesh K. Gupta

Authors
  1. Mazhar Husain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deepak K. Jha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Manu Rastogi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nuzhat Husain
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rakesh K. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mazhar Husain.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Husain, M., Jha, D.K., Rastogi, M. et al. Role of neuroendoscopy in the management of patients with tuberculous meningitis hydrocephalus. Neurosurg Rev 28, 278–283 (2005). https://doi.org/10.1007/s10143-005-0397-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-005-0397-2

Keywords

Search

Navigation