Hyaluronidase as an adjuvant in the treatment of cranial arachnoiditis (hydrocephalus and optochiasmatic arachnoiditis) complicating tuberculous meningitis.

Abstract

Use of subarachnoid/intraventricular administration of hyaluronidase in the treatment of 15 cases of cranial arachnoiditis which occurred as a complication of tuberculous meningitis is reported. Eleven of these cases had communicating hydrocephalus and four had optochiasmatic arachnoiditis. An average of 4.5 injections were administered at weekly to fortnightly intervals. These patients had been followed-up for a mean period of 6.1 months per patient. Serious side effects such as flare-up of the underlying meningitis process, miliary spread of tuberculosis, convulsions or allergic reactions were not observed. Improvement of sensorium and/or neurological deficit was observed in 14 of the 15 cases. A clinically comparable group of 15 cases subjected to shunt surgery (14) and ventricular drainage (1) were considered as "control". This medical method of treatment appears to be superior to shunt surgery and offers a simpler alternative line of management of cranial arachnoiditis/hydrocephalus complicating tuberculous meningitis.