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Role of Endoscopic Third Ventriculostomy in Tuberculous Meningitis with Hydrocephalus

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Tuberculosis of the Central Nervous System

Abstract

Hydrocephalus in tuberculous meningitis (TBM) could be obstructive, communicating, or due to combinations of obstructive and communicating variety. Endoscopic third ventriculostomy (ETV) is an established management option for obstructive hydrocephalus in chronic phase. ETV in TBM hydrocephalus could be a demanding surgical procedure especially in acute stage secondary to opaque, thick, and inflamed third ventricle floor. Water-jet dissection is indicated in such patients, while blunt perforation is preferred in thin and transparent third ventricle floor. Intraoperative Doppler or neuronavigation can help in proper planning of the perforation and to prevent neurovascular complications. Choroid plexus coagulation along with ETV could improve success rate especially in infants. Results of ETV are superior in good grade as compared to poor grade. Poor results are described in patients with thick and opaque third ventricle floor, cisternal exudates, malnourished cases, and in acute phase as compared to patients with thin and transparent floor, without cisternal exudates, well-nourished cases, and in chronic phase, respectively. Some of the patients especially in poor grade could show delayed recovery. Failure to improve after surgical procedure could be due to stoma block, complex hydrocephalus, vascular compromise, and in poor grade. Postoperative high intracranial pressure (ICP) has been observed following ETV. Repeated lumbar puncture/external ventricular drainage could help in faster normalization of the ICP after ETV in patients with temporary defect in cerebrospinal fluid absorption, while lumbar peritoneal shunt is required in permanent defect. Repeat ETV is recommended if the stoma is blocked.

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Abbreviations

CISS:

Constructive interference in steady state

CSF:

Cerebrospinal fluid

CT:

Computed tomography

ETV:

Endoscopic third ventriculostomy

EVD:

External ventricular drainage

ICP:

Intracranial pressure

MR:

Magnetic resonance

MRI:

Magnetic resonance imaging

PC:

Phase contrast

PCR:

Polymerase chain reaction

TBM:

Tuberculous meningitis

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Authors and Affiliations

  1. Department of Neurosurgery, NSCB Medical College Jabalpur, Madhya Pradesh, 482003, India

    Y. R. Yadav MCh, Vijay Parihar Mch, Shailendra Ratre Mch & Jitin Bajaj Mch

  2. Department of Radiodiagnosis and imaging, All India Institute of Medical Sciences, New Delhi, India

    Nishtha Yadav MD

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  1. Y. R. Yadav MCh
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  3. Vijay Parihar Mch
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  5. Jitin Bajaj Mch
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Correspondence to Y. R. Yadav MCh .

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  1. Adnan Menderes University, School of Medicine, Aydın, Turkey

    Mehmet Turgut

  2. Mohammed V University in Rabat, Avicenne Military Hospital of Marrakech, Rabat, Morocco

    Ali Akhaddar

  3. Hacettepe University, School of Medicine, Ankara, Turkey

    Ahmet T. Turgut

  4. King George Medical University, Lucknow, Uttar Pradesh, India

    Ravindra K. Garg

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Yadav, Y.R., Yadav, N., Parihar, V., Ratre, S., Bajaj, J. (2017). Role of Endoscopic Third Ventriculostomy in Tuberculous Meningitis with Hydrocephalus. In: Turgut, M., Akhaddar, A., Turgut, A., Garg, R. (eds) Tuberculosis of the Central Nervous System. Springer, Cham. https://doi.org/10.1007/978-3-319-50712-5_30

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