Giant central nervous system tuberculoma in pediatric patients: surgical case series

Qiang Li,Xiao Xiao,Yan Ju

doi:10.1007/s00381-021-05091-1

Qiang Li, Xiao Xiao + Show 1 more

Open Access

https://doi.org/10.1007/s00381-021-05091-1

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Abstract

Central nervous system tuberculoma is rare and challenging situation. Clinical records of patients with pathologically proven tuberculoma were retrospectively reviewed. Clinical presentation, lesion location, radiological characteristics, perioperative and surgical management, and outcome is summarized and analyzed. Eight patients were included and there was one girl. Age ranged from 3 to 14 years with mean age 9.8 years. Clinical duration ranged from 20 days to 2 years, and 3 patients had previous lung tuberculosis with anti-TB treatment. The lesion was in cerebellum in 6 cases, including 1 involving basal ganglia and 1 involving thalamus. The lesion was in basal ganglia, thalamus, and third ventricle in 1 case, and in T12-L1 spinal cord in another. Cerebellar lesion was resected via paramedian suboccipital approach in 5 patients, basal ganglia lesion via trans-cortical frontal horn approach in 2 patients, and intra-spinal lesion via trans-laminar approach in 1 patient. Follow-up ranged from 10 to 24 months. Of the 8 patients, 6 returned to normal life. One patient had cerebellar lesion resected and the thalamic lesion reduced in size after anti-TB treatment. One patient died from TB spreading. Our data showed that most patients can be successfully treated by resection of the lesion. Low T2 signal, ring shaped enhancement and peripheral edema strongly suggest tuberculoma. Empirical anti-TB treatment should be initiated perioperatively.

Highlights

Tuberculosis (TB) is a common chronic infectious disease in developing countries and is a major threat to public health
TB is usually caused by Mycobacterium tuberculosis and manifests as lung TB, meningitis, tuberculoma, lymphadenopathy, or gastrointestinal TB
CNS-TB accounts for about 5–10% of all patients, with a mortality up to 20% depending on the clinical stage [2, 3] Most CNS-TB patients are treated medically

Summary

Introduction

Tuberculosis (TB) is a common chronic infectious disease in developing countries and is a major threat to public health. There were 47,698 new tuberculosis case notifications, including 1378 in China. In 2012, there were around totally 530,000 TB cases in children and 74,000 deaths among them [1]. TB is usually caused by Mycobacterium tuberculosis and manifests as lung TB, meningitis, tuberculoma, lymphadenopathy, or gastrointestinal TB. The involvement of central nervous system (CNS-TB) is the most severe form of tubercle bacillus infection. CNS tuberculoma is a rare entity in the pediatric population, and very few cases have been reported [4,5,6]. We review and report eight pediatric patients with giant tuberculomas involving the CNS. The clinical features and management of the giant tuberculomas are discussed

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