Shunting in tuberculous meningitis: a neurosurgeon’s nightmare

Abstract

In a developing country like India, tuberculosis is very common in spite of a mass vaccination programme. Meningitis, progressive arteritis, adhesive arachnoiditis and tuberculomas represent the wide spectrum of this potentially lethal disease. Hydrocephalus occurs in about one third of the patients with central nervous system tuberculosis. Majority of patients have large fourth ventricles with adhesive obstructions in the basal cerebrospinal fluid (CSF) cisterns. Aggressive CSF diversion does not always alter the course of the disease. Endoscopic procedures are rarely, if ever, successful. Ventriculo-peritoneal shunting is fraught with complications like high rate of infection and shunt tube blockage. So there is clearly a need to explore methods of CSF diversion. In our series of 32 patients, we present the indications, prognostic indicators and types of shunt with the clinical outcome of childhood tuberculous meningitis. Even though the results are far from satisfactory, early shunting still remains the best option to prevent long-term neurological sequelae.