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Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy.
J Neurosurg Pediatr. 2009 May; 3(5):371-7.JN

Abstract

OBJECT

Endoscopic third ventriculostomy (ETV) is increasingly being used as an alternative treatment for post-tuberculous meningitis (TBM) hydrocephalus. The aim of this study was to affirm the role of ETV in patients with TBM hydrocephalus and also to study the usefulness of cine phase-contrast MR imaging (cine MR imaging) for functional assessment of the ETV stoma. An additional goal was to identify factors that influence the outcome of ETV, so as to define patients with TBM hydrocephalus in whom ETV is warranted.

METHODS

Twenty-six patients with TBM hydrocephalus treated with ETV were evaluated clinically and with cine MR imaging postoperatively. The duration of follow-up ranged from 1 to 15 months. The authors evaluated flow void changes in the floor of the third ventricle and analyzed parameters from the preoperative data, which they then used as a basis for comparison between endoscopically successful and endoscopically unsuccessful cases.

RESULTS

The overall success rate of ETV in TBM hydrocephalus was 73.1% in this case series. Cine MR imaging showed a sensitivity of 94.73% and specificity of 71.42% for the functional assessment of third ventriculostomy in these patients, with the efficacy being maintained during follow-up. The outcome of ETV showed a statistically significant correlation with the stage of illness and presence of intraoperative cisternal exudates. Although duration of symptoms and duration of preoperative antituberculous therapy (ATT) appeared to influence the outcome, their correlation with outcome was not statistically significant.

CONCLUSIONS

Endoscopic third ventriculostomy should be considered as the first surgical option for CSF diversion (that is, before shunt surgery) in patients with TBM hydrocephalus. Cine MR imaging is a highly effective noninvasive tool for the postoperative functional assessment of stomata. Patients who presented with a history of longer duration and those who were administered preoperative ATT for a longer period had a better outcome of endoscopic treatment. Outcome was poorer in patients who presented with higher stages of illness and in those in whom cisternal exudates were observed intraoperatively.

Authors+Show Affiliations

Department of Neurosurgery, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India. apchugh@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19409015

Citation

Chugh, Ashish, et al. "Surgical Outcome of Tuberculous Meningitis Hydrocephalus Treated By Endoscopic Third Ventriculostomy: Prognostic Factors and Postoperative Neuroimaging for Functional Assessment of Ventriculostomy." Journal of Neurosurgery. Pediatrics, vol. 3, no. 5, 2009, pp. 371-7.
Chugh A, Husain M, Gupta RK, et al. Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy. J Neurosurg Pediatr. 2009;3(5):371-7.
Chugh, A., Husain, M., Gupta, R. K., Ojha, B. K., Chandra, A., & Rastogi, M. (2009). Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy. Journal of Neurosurgery. Pediatrics, 3(5), 371-7. https://doi.org/10.3171/2009.1.PEDS0947
Chugh A, et al. Surgical Outcome of Tuberculous Meningitis Hydrocephalus Treated By Endoscopic Third Ventriculostomy: Prognostic Factors and Postoperative Neuroimaging for Functional Assessment of Ventriculostomy. J Neurosurg Pediatr. 2009;3(5):371-7. PubMed PMID: 19409015.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy. AU - Chugh,Ashish, AU - Husain,Mazhar, AU - Gupta,Rakesh K, AU - Ojha,Bal K, AU - Chandra,Anil, AU - Rastogi,Manu, PY - 2009/5/5/entrez PY - 2009/5/5/pubmed PY - 2009/6/26/medline SP - 371 EP - 7 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 3 IS - 5 N2 - OBJECT: Endoscopic third ventriculostomy (ETV) is increasingly being used as an alternative treatment for post-tuberculous meningitis (TBM) hydrocephalus. The aim of this study was to affirm the role of ETV in patients with TBM hydrocephalus and also to study the usefulness of cine phase-contrast MR imaging (cine MR imaging) for functional assessment of the ETV stoma. An additional goal was to identify factors that influence the outcome of ETV, so as to define patients with TBM hydrocephalus in whom ETV is warranted. METHODS: Twenty-six patients with TBM hydrocephalus treated with ETV were evaluated clinically and with cine MR imaging postoperatively. The duration of follow-up ranged from 1 to 15 months. The authors evaluated flow void changes in the floor of the third ventricle and analyzed parameters from the preoperative data, which they then used as a basis for comparison between endoscopically successful and endoscopically unsuccessful cases. RESULTS: The overall success rate of ETV in TBM hydrocephalus was 73.1% in this case series. Cine MR imaging showed a sensitivity of 94.73% and specificity of 71.42% for the functional assessment of third ventriculostomy in these patients, with the efficacy being maintained during follow-up. The outcome of ETV showed a statistically significant correlation with the stage of illness and presence of intraoperative cisternal exudates. Although duration of symptoms and duration of preoperative antituberculous therapy (ATT) appeared to influence the outcome, their correlation with outcome was not statistically significant. CONCLUSIONS: Endoscopic third ventriculostomy should be considered as the first surgical option for CSF diversion (that is, before shunt surgery) in patients with TBM hydrocephalus. Cine MR imaging is a highly effective noninvasive tool for the postoperative functional assessment of stomata. Patients who presented with a history of longer duration and those who were administered preoperative ATT for a longer period had a better outcome of endoscopic treatment. Outcome was poorer in patients who presented with higher stages of illness and in those in whom cisternal exudates were observed intraoperatively. SN - 1933-0707 UR - https://www.unboundmedicine.com/medline/citation/19409015/Surgical_outcome_of_tuberculous_meningitis_hydrocephalus_treated_by_endoscopic_third_ventriculostomy:_prognostic_factors_and_postoperative_neuroimaging_for_functional_assessment_of_ventriculostomy_ L2 - https://thejns.org/doi/10.3171/2009.1.PEDS0947 DB - PRIME DP - Unbound Medicine ER -