Role of Surgery in Intracranial Tuberculomas and Proposal of a Novel Diagnostic Criteria for Diagnosis (Sri Venkateswara Institute of Medical Sciences Criteria)

Abstract

Intracranial tuberculomas (IT) are often misdiagnosed or overdiagnosed, resulting either in delay in treatment of this curable illness or in unnecessary surgical intervention. A new method of diagnostic criteria for preoperative diagnosis of IT is proposed. A retrospective analysis was performed of all patients with a preoperatively suspected diagnosis of IT who were operated on at our institute from 2010 to 2019. The patients were divided into 2 groups: biopsy-proven IT and biopsy ruled out IT. Tests of diagnostic accuracy were applied for each finding. A total of 69 patients were operated on in the given period, 40 of whom were proved by biopsy as having tuberculoma. In the remaining 29 patients, the biopsy ruled out tuberculoma. Three features were identified as major criteria and 7 features were identified as minor criteria. We suggest that the diagnosis of IT should be made preoperatively, in the presence of 3 major criteria, 2 major and 3 minor criteria, 1 major and 5 minor criteria, or 7 minor criteria. By applying these diagnostic criteria to each of the 69 patients, we could diagnose IT in all 40 patients and exclude IT in all 29 patients preoperatively. We suggest that empirical antituberculous treatment should be started in a patient without the need for invasive surgery if our criteria are met. If thecriteria are not met, we suggest further evaluation of the patient for an alternative diagnosis or early surgery for definitive management. Surgery decreases the duration of antituberculous treatment and helps in early resolution of lesions.