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.

Keywords:
Tuberculous meningitis, Hydrocephalus, Child, Ventriculoperitoneal shunts, Timing
1.
TerBrugge KG, Rao KCVG, Lee HS: Cranial Computed Tomography. Hydrocephalus and Atrophy. London, Elsevier Science, 1995, p 231.
2.
Hosoglu S, Ayaz C, Geyik MF, Kokoglu OF, Ceviz A: Tuberculous meningitis in adults: An eleven-year review. Int J Tuberc Lung Dis 1998;2:553–557.
3.
Özates M, Kemaloglu S, Gürkan F, Özkan Ü, Hosoglu S, Şimşek MM: CT of the brain in tuberculous meningitis. A review of 289 patients. Acta Radiol 2000;41:13–17.
4.
Yaramiş A, Gürkan F, Elevli M, Söker M, Haspolat K, Kirbas G, Taş MA: Central nervous system tuberculosis in children: A review of 214 cases. Pediatrics 1998;100:49–54.
5.
Palur R, Rajeshekhar V, Chandy MJ, Joseph T, Abraham J: Shunt surgery for hydrocephalus in tuberculous meningitis: Along-term follow-up study. J Neurosurg 1991;74:64–69.
6.
Mathew JM, Rajeshekhar V, Chandy MJ: Shunt surgery in poor grade patients with tuberculous meningitis and hydrocephalus: Effects of response to external ventricular drainage and other variables on long term outcome. J Neurol Neurosurg Psychiatry 1998;65:115–118.
7.
Kingsley DP, Hendrickse WA, Kendall BE, Swash M, Singh V: Tuberculous meningitis: Role of CT in management and prognosis. J Neurol Neurosurg Psychiatry 1987;50:30–36.
8.
Bhagwati SN: Ventriculoatrial shunt in tuberculous meningitis with hydrocephalus. J Neurosurg 1987;35:309–313.
9.
Lamprecht D, Schoeman J, Donald P, Hartzenberg H: Ventriculoperitoneal shunting in childhood tuberculous meningitis. Br J Neurosurg 2001;15:119–125.
10.
Schoeman JF, Laubscher JA, Donald PR: Serial lumbar CSF pressure measurements and cranial computed tomographic findings in childhood tuberculous meningitis. Childs Nerv Syst 2000;16:203–239.
11.
Gropper MR, Schulder M, Sharan AD, Cho ES: Central nervous system tuberculosis: Medical management and surgical indications. Surg Neurol 1995;44:378–385.
12.
Gelabert M, Castro-Gago M: Hydrocephalus and tuberculous meningitis in children. Report on 26 cases. Childs Nerv Syst 1988;4:268–270.
13.
Lincoln EM, Sabato SVR, Davies PA: Tuberculous meningitis in children. A review of 167 untreated and 74 treated patients with special reference to early diagnosis. J Pediar 1960;57:807–823.
14.
Kent SJ, Crowe SM, Yung A, Lucas CR, Mijch MA: Tuberculous meningitis: A 30-year review. Clin Infect Dis 1993;17:987–994.
15.
Misra UK, Kalita J, Roy AK, Mandal SK, Srivastava M: Role of clinical, radiological, and neurophysiological changes in predicting the outcome of tuberculous meningitis: A multivariable analysis. J Neurol Neurosurg Psychiatry 2000;68:300–303.
16.
Kalita J, Misra UK: EEG changes in tuberculous meningitis: A clinicoradiological correlation. Electroencephalogr Clin Neurophysiol 1998;107:39–43.
17.
Farinha NJ, Razali KA, Holzel H, Morgan G, Novelli VM: Tuberculosis of the central nervous system in children: A 20-year survey. J Infect 2000;41:61–68.
18.
Wallace RC, Burton EM, Barret FF, Leggiadro RJ, Gerald BE, Lasater OE: Intracranial tuberculosis in children: CT appearance and clinical outcome. Pediatr Radiol 1991;21:241–246.
19.
Teoh R, Humphries MJ, Hoare RD, O’Mahony G: Clinical correlation of CT changes in 64 Chinese patients with tuberculous meningitis. J Neurol 1989;236:48–51.
20.
Tan EK, Chee MWL, Chan LL, Lee YL: Culture positive tuberculous meningitis: Clinical indicators of poor prognosis. Clinical Neurol Neurosurg 1999;101:157–160.
21.
Greitz D, Greitz T: The pathogenesis and hemodynamics of hydrocephalus. Proposal for a new understanding. Int J Neuroradiol 1997;3:367–375.
22.
Misra UK, Kalita J, Srivastava M, Mandal SK: Prognosis of tuberculous meningitis: A multivariate analysis. J Neurol Sci 1996;137:57–61.
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2002
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