Article

Timing of shunt surgery in childhood tuberculous meningitis with hydrocephalus.

Department of Neurosurgery, School of Medicine, Dicle University, Diyarbakir, Turkey.
Pediatric Neurosurgery (impact factor: 0.7). 11/2002; 37(4):194-8. DOI:65398 pp.194-8
Source: PubMed

ABSTRACT Hydrocephalus is a common complication of tuberculous meningitis (TBM) in children. The aims of this study are to review our experience of hydrocephalus in childhood TBM and to evaluate the effect of the timing of ventriculoperitoneal shunting (VPS) on the final outcome. In this study, 156 patients with TBM and hydrocephalus were reviewed retrospectively between 1990 and 2000. Patients' ages ranged from 6 months to 15 years, with a mean age of 4.1 years. There were 85 boys, and the male-to-female ratio was 1.19:1.0. Sixty-two percent of the children were younger than 6 years old. VPS was performed 2 days after the diagnosis in 100 patients, and in the remaining 56 patients, 3 weeks after the diagnosis. The average follow-up period was 8.5 months. Good recovery or minor sequelae was seen in 82 patients (52.6%), and 51 died (12.3%). The timing of the VPS procedure and cerebral complications had an effect on the final outcome. Early VPS gave a better outcome in mild and moderate hydrocephalus (p = 0.040). This study has shown that early surgical procedure for mild/moderate hydrocephalus has a positive effect on the morbidity and mortality of hydrocephalus in childhood TBM (p = 0.014, p = 0.040, respectively). In severe hydrocephalus, there was a tendency for early shunting to have a positive effect on morbidity, although this did not reach statistical significance.

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Keywords

2 days
 
3 weeks
 
6 months
 
6 years old
 
82 patients
 
average follow-up period
 
cerebral complications
 
childhood TBM
 
common complication
 
final outcome
 
Good recovery
 
minor sequelae
 
Patients' ages
 
positive effect
 
severe hydrocephalus
 
statistical significance
 
surgical procedure
 
ventriculoperitoneal shunting
 
VPS
 
VPS procedure