Shunt surgery for hydrocephalus in tuberculous meningitis: a long-term follow-up study

Ravi Palur M.Ch. 1 , Vedantam Rajshekhar M.Ch. 1 , Mathew J. Chandy M.Ch. 1 , Thomas Joseph M.S.(Neuro) 1 , and Jacob Abraham M.S.(Neuro) 1
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  • 1 Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India
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✓ Hydrocephalus is a common complication of tuberculous meningitis. Case studies of 114 patients with tuberculous meningitis and hydrocephalus, who underwent shunt surgery between July, 1975, and June, 1986, were reviewed to evaluate the long-term outcome and to outline a management protocol for these patients based on the results. Seven factors were studied in each case: 1) age at admission; 2) grade on admission (I to IV, classified by the authors: Grade I being the best and Grade IV being the worst); 3) duration of alteration of sensorium; 4) cerebrospinal fluid (CSF) cell content at initial examination; 5) CSF protein levels at initial examination; 6) number of shunt revisions required; and 7) the necessity for bilateral shunts. During a long-term follow-up period ranging from 6 months to 13 years (mean 45.6 months), the mortality rate was 20% for patients in Grade I; 34.7% for patients in Grade II; 51.9% for patients in Grade III; and 100% for patients in Grade IV. Only the grade at the time of admission was found to be statistically significant in determining final outcome (p < 0.001). Based on these results, the authors advocate early shunt surgery for Grade I and II patients. For patients in Grade III, surgery may be performed either if external ventricular drainage causes an improvement in sensorium or without selection. All patients in Grade IV should undergo external ventricular drainage and only those who show a significant change in their neurological status within 24 to 48 hours of drainage, should have shunt surgery.

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Contributor Notes

Address reprint requests to: Vedantam Rajshekhar, M.Ch., Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, 2 Maynard Street, Hanover, New Hampshire 03756.
  • 1.

    Bhagwati SN: Ventriculoatrial shunt in tuberculous meningitis with hydrocephalus. J Neurosurg 35:309313, 1971 Bhagwati SN: Ventriculoatrial shunt in tuberculous meningitis with hydrocephalus. J Neurosurg 35:309–313, 1971

    • Search Google Scholar
    • Export Citation
  • 2.

    Bharucha PE, & Potdar RD: An analysis of patients treated at KEM Hospital, Bombay, during a four year period 1961–64. Indian Pediatr 4:341346, 1967 Bharucha PE, Potdar RD: An analysis of patients treated at KEM Hospital, Bombay, during a four year period 1961–64. Indian Pediatr 4:341–346, 1967

    • Search Google Scholar
    • Export Citation
  • 3.

    Bullock MRR, & Van Dellen JR: The role of cerebrospinal fluid shunting in tuberculous meningitis. Surg Neurol 18:274277, 1982 Bullock MRR, Van Dellen JR: The role of cerebrospinal fluid shunting in tuberculous meningitis. Surg Neurol 18:274–277, 1982

    • Search Google Scholar
    • Export Citation
  • 4.

    Cairns H: Neurosurgical methods in the treatment of tuberculous meningitis with a note on some unusual manifestations of the disease. Arch Dis Child 26:373386, 1951 Cairns H: Neurosurgical methods in the treatment of tuberculous meningitis with a note on some unusual manifestations of the disease. Arch Dis Child 26:373–386, 1951

    • Search Google Scholar
    • Export Citation
  • 5.

    Clark WC, , Metcalf JC Jr, & Muhlbauer MS, et al: Mycobacterium tuberculosis meningitis: a report of twelve cases and a literature review. Neurosurgery 18:604609, 1986 Clark WC, Metcalf JC Jr, Muhlbauer MS, et al: Mycobacterium tuberculosis meningitis: a report of twelve cases and a literature review. Neurosurgery 18:604–609, 1986

    • Search Google Scholar
    • Export Citation
  • 6.

    Dastur DK, & Lalitha VS: The many facets of neurotuberculosis: an epitome of neuropathology, in Zimmerman HM (ed): Progress in Neuropathology. New York: Grune & Stratton, 1973, Vol 2, pp 351408 Dastur DK, Lalitha VS: The many facets of neurotuberculosis: an epitome of neuropathology, in Zimmerman HM (ed): Progress in Neuropathology. New York: Grune & Stratton, 1973, Vol 2, pp 351–408

    • Search Google Scholar
    • Export Citation
  • 7.

    Dastur HM, , Pandya SK, & Rao YC: Aetiology of hydrocephalus in tuberculous meningitis. Neurol India Suppl 1:73, 1972 (Abstract) Dastur HM, Pandya SK, Rao YC: Aetiology of hydrocephalus in tuberculous meningitis. Neurol India Suppl 1:73, 1972 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 8.

    De SN: Streptomycin in development of hydrocephalus in tuberculous meningitis. Br Med J 1:214216, 1949 De SN: Streptomycin in development of hydrocephalus in tuberculous meningitis. Br Med J 1:214–216, 1949

    • Search Google Scholar
    • Export Citation
  • 9.

    Deshpande DH, , Bharucha EP, & Mondkar VP: Tuberculous meningitis in adults: a clinicopathological study of 18 cases. Neurol India 17:2834, 1969 Deshpande DH, Bharucha EP, Mondkar VP: Tuberculous meningitis in adults: a clinicopathological study of 18 cases. Neurol India 17:28–34, 1969

    • Search Google Scholar
    • Export Citation
  • 10.

    Gelabert M, & Castro-Gago M: Hydrocephalus and tuberculous meningitis in children. Childs Nerv Syst 4:268270, 1988 Gelabert M, Castro-Gago M: Hydrocephalus and tuberculous meningitis in children. Childs Nerv Syst 4:268–270, 1988

    • Search Google Scholar
    • Export Citation
  • 11.

    Idris ZH, , Sinno AA, & Kronfol NM: Tuberculous meningitis in childhood. Forty three cases. Am J Dis Child 130:364367, 1976 Idris ZH, Sinno AA, Kronfol NM: Tuberculous meningitis in childhood. Forty three cases. Am J Dis Child 130:364–367, 1976

    • Search Google Scholar
    • Export Citation
  • 12.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 13.

    Jha SS: Preventive aspects of tuberculous meningitis, in: Tuberculosis of the Nervous System. New Delhi: Indian Academy of Medical Sciences, 1973, p 9 Jha SS: Preventive aspects of tuberculous meningitis, in: Tuberculosis of the Nervous System. New Delhi: Indian Academy of Medical Sciences, 1973, p 9

    • Search Google Scholar
    • Export Citation
  • 14.

    Khatua SP: Tuberculous meningitis in children: analysis of 213 cases. J Indian Med Assoc 37:332337, 1961 Khatua SP: Tuberculous meningitis in children: analysis of 213 cases. J Indian Med Assoc 37:332–337, 1961

    • Search Google Scholar
    • Export Citation
  • 15.

    Kocen RS: Tuberculous meningitis. Br J Hosp Med 18:436445, 1977 Kocen RS: Tuberculous meningitis. Br J Hosp Med 18:436–445, 1977

  • 16.

    Lincoln EM, , Sordillo SVR, & Da vies PA: Tuberculous meningitis in children. J Pediatr 57:807823, 1960 Lincoln EM, Sordillo SVR, Da vies PA: Tuberculous meningitis in children. J Pediatr 57:807–823, 1960

    • Search Google Scholar
    • Export Citation
  • 17.

    Lorber J: Studies of CSF circulation in tuberculous meningitis. II. A review of 100 pneumoencephalograms. Arch Dis Child 26:2848, 1951 Lorber J: Studies of CSF circulation in tuberculous meningitis. II. A review of 100 pneumoencephalograms. Arch Dis Child 26:28–48, 1951

    • Search Google Scholar
    • Export Citation
  • 18.

    Medical Research Council: Streptomycin treatment of tuberculous meningitis in tuberculosis trial. Report of the committee on streptomycin in tuberculous trial. Lancet 1:582596, 1948 Medical Research Council: Streptomycin treatment of tuberculous meningitis in tuberculosis trial. Report of the committee on streptomycin in tuberculous trial. Lancet 1:582–596, 1948

    • Search Google Scholar
    • Export Citation
  • 19.

    Murray HW, , Bransetter R, & Lavyne MH: Ventriculoatrial shunt for hydrocephalus complicating tuberculous meningitis. Am J Med 70:895898, 1981 Murray HW, Bransetter R, Lavyne MH: Ventriculoatrial shunt for hydrocephalus complicating tuberculous meningitis. Am J Med 70:895–898, 1981

    • Search Google Scholar
    • Export Citation
  • 20.

    Newman PK, , Cummings WJ, & Foster JB: Hydrocephalus and tuberculous meningitis in adults. J Neurol Neurosurg Psychiatry 43:188190, 1980 Newman PK, Cummings WJ, Foster JB: Hydrocephalus and tuberculous meningitis in adults. J Neurol Neurosurg Psychiatry 43:188–190, 1980

    • Search Google Scholar
    • Export Citation
  • 21.

    Peto R, , Pike MC, & Armitage P, et al: Design and analysis of randomized clinical trials requiring prolonged observation of each patient. Part 2: Analysis and examples. Br J Cancer 35:139, 1977 Peto R, Pike MC, Armitage P, et al: Design and analysis of randomized clinical trials requiring prolonged observation of each patient. Part 2: Analysis and examples. Br J Cancer 35:1–39, 1977

    • Search Google Scholar
    • Export Citation
  • 22.

    Prasad S: Etio-epidemiology of tuberculous meningitis in children. Indian J Child Health 12:110, 1963 (Abstract) Prasad S: Etio-epidemiology of tuberculous meningitis in children. Indian J Child Health 12:110, 1963 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 23.

    Roy TK, , Sircar PK, & Chandar V: Ventriculoatrial shunt in the management of tuberculous meningitis. Indian J Pediatr 16:10231027, 1979 Roy TK, Sircar PK, Chandar V: Ventriculoatrial shunt in the management of tuberculous meningitis. Indian J Pediatr 16:1023–1027, 1979

    • Search Google Scholar
    • Export Citation
  • 24.

    Sheth SC: Extrapulmonary tuberculosis. J Indian Med Assoc 37:443446, 1961 Sheth SC: Extrapulmonary tuberculosis. J Indian Med Assoc 37:443–446, 1961

    • Search Google Scholar
    • Export Citation
  • 25.

    Singhal BS, , Bhagwati SN, & Syed AH, et al: Raised intracranial pressure in tuberculous meningitis. Neurol India 23:3239, 1975 Singhal BS, Bhagwati SN, Syed AH, et al: Raised intracranial pressure in tuberculous meningitis. Neurol India 23:32–39, 1975

    • Search Google Scholar
    • Export Citation
  • 26.

    Smith HV, , Vollum RL, & Cairns H: Treatment of tuberculous meningitis with streptomycin (a report of the MRC). Lancet 1:627636, 1948 Smith HV, Vollum RL, Cairns H: Treatment of tuberculous meningitis with streptomycin (a report of the MRC). Lancet 1:627–636, 1948

    • Search Google Scholar
    • Export Citation
  • 27.

    Tandon PN: Tuberculous meningitis (cranial and spinal), in Vinken PJ, & Bruyn GW (eds): Handbook of Clinical Neurology. Infections of the Nervous System. Amsterdam: North-Holland, 1978, Vol 33, pp 195262 Tandon PN: Tuberculous meningitis (cranial and spinal), in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology. Infections of the Nervous System. Amsterdam: North-Holland, 1978, Vol 33, pp 195–262

    • Search Google Scholar
    • Export Citation
  • 28.

    Tandon PN, , Bhatia R, & Bhargava S: Tuberculous meningitis, in Vinken PJ, , Bruyn GW, & Klawans HL (eds): Handbook of Clinical Neurology. Microbial Disease. Amsterdam: Elsevier, 1988, Vol 52, pp 195226 Tandon PN, Bhatia R, Bhargava S: Tuberculous meningitis, in Vinken PJ, Bruyn GW, Klawans HL (eds): Handbook of Clinical Neurology. Microbial Disease. Amsterdam: Elsevier, 1988, Vol 52, pp 195–226

    • Search Google Scholar
    • Export Citation
  • 29.

    Tandon PN, & Pathak SN: Tuberculosis of the central nervous system, in Spillane JW (ed): Tropical Neurology. London: Oxford University Press, 1973, pp 3751 Tandon PN, Pathak SN: Tuberculosis of the central nervous system, in Spillane JW (ed): Tropical Neurology. London: Oxford University Press, 1973, pp 37–51

    • Search Google Scholar
    • Export Citation
  • 30.

    Udani PM: Incidence of tuberculosis in children. Indian J Child Health 10:515524, 1961 Udani PM: Incidence of tuberculosis in children. Indian J Child Health 10:515–524, 1961

    • Search Google Scholar
    • Export Citation

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