Publication year: 2012
Source: World Neurosurgery, Available online 10 February 2012
Anthony A. Figaji, A. Graham Fieggen
Endoscopy for hydrocephalus due to infectious diseases presents clear challenges to the surgeon. Hydrocephalus due to tuberculous meningitis (TBM) is a good model to explore many of the issues that should be considered in the management of these patients. Tuberculous hydrocephalus may be communicating (CommHC) or non-communicating (NCHC); management options include medical treatment (for CommHC), ventriculoperitoneal shunting, and endoscopic third ventriculostomy (ETV). No guidelines exist currently, so management protocols are center-specific. Because brain ischemia due to vasculitis is common in these patients, optimal treatment of intracranial pressure (ICP) is even more important than usual, and this has implications for the management decisions. Effective treatment of these patients should lead to normalisation of ICP and resolution of the hydrocephalus, rather than merely avoiding extreme elevations of ICP. However, this also must be weighed against the surgical and long term complications associated with the procedures employed. There are specific endoscopic challenges that occur due to abnormal anatomy and the fact that hydrocephalus presents during the acute phase of the disease, rather than beingpost-infectious. In this article we examine the arguments for various therapeutic approaches and discuss the gathering experience in the literature about endoscopy in TBM in the context of overall management options.
Júlio Leonardo B. Pereira
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