Clinical analysis of ventriculoperitoneal shunt for grade IV tuberculous meningitis children with hydroce-phalus

Abstract

Objective To explore the effects of ventriculoperitoneal shunt(VPS)placement in those children with grade Ⅳ tuberculous meningitis with hydrocephalus(TBMH)clinical analysis. Methods Nine cases of grade Ⅳ TBMH who received VPS from Jan.2006 to Dec.2009 were retrospectively reviewed, including age, gender, disease development, clinical manifestations, laboratory data, treatment, prognosis and complications.All children received VPS placement combined with pharmacal treatment.External ventricular drainage(EVD)were given only 2 cases with severe biochemical derangements or brainstem dysfunction requiring correction before shunt surgery.Outcomes were divided into normal, mild sequelae, severe sequelae, death or vegetable status. Results The average follow-up period was 15 months.Two patients had a full recovery, 3 patients had slight sequelae, 2 patients had severe sequela, and another 2 patients expired.Four cases complications related to the shunt surgery were seen, 1 patient had shunt block, 2 patients had infections and 1 patient had subdural effusion and ventricular hemorrhage. Conclusions Directly VPS surgery can improve the outcome of grade Ⅳ TBMH.The response of EVD is not a reliable indication for selecting patients who would benefit from shunt surgery. Key words: Tuberculous meningitis; Hydrocephalus; Ventriculoperitoneal shunt; Child