We present a case of prepontine-suprasellar tuberculoma involving the premamillary region of the third ventricular floor, a site suitable to perform an endoscopic third ventriculostomy (ETV) stoma, managed endoscopically, and discuss our findings. A 5-year-old male child was admitted in an unconscious state with a history of gradually progressive symptoms of raised intracranial pressure and low-grade fever for the last 3 months. Head computed tomography showed thick enhancing basal exudates, a prepontine-suprasellar ring-enhancing lesion with consequent obstructive hydrocephalus. The child was subjected to urgent endoscopy which revealed multiple ependymal tubercles along with prepontine-suprasellar tuberculoma involving the premamillary region of the third ventricular floor. The tuberculoma was decompressed using a 5-french catheter, and ETV was performed. Postoperatively, the child improved clinicoradiologically on antitubercular chemotherapy and needed no further cerebrospinal fluid diversion surgery; he is under regular follow-up. We conclude that ETV may be attempted even in the presence of thick basal exudates and/or prepontine-suprasellar tuberculoma.

1.
Figaji AA, Fieggen AG, Peter JC: Endoscopic third ventriculostomy in tuberculous meningitis. Childs Nerv Syst 2003;19:217–225.
2.
Husain M, Jha D, Vatsal DK, Thaman D, Gupta A, Husain N, Gupta RK: Neuroendoscopic surgery – experience and outcome analysis of 102 consecutive procedures in a busy neurosurgical centre of India. Acta Neurochir (Wien) 2003;145:369–376.
3.
Sufainov AA, Il’ina GP, Frolova EV: Endoscopic ventriculocisternostomy in the treatment of complications of tuberculous meningoencephalitis in an infant. Probl Tuberk 2001;1:48–51.
4.
Jonathan A, Rajshekhar V: Endoscopic third ventriculostomy for chronic hydrocephalus after tuberculous meningitis. Surg Neurol 2005;63:32–35.
5.
Husain M, Jha DK, Rastogi M, Husain N, Gupta RK: Role of neuroendoscopy in the management of patients with tuberculous meningitis hydrocephalus. Neurosurg Rev 2005;28:278–283.
6.
Singh D, Sachdev V, Singh AK, Sinha S: Endoscopic third ventriculostomy in post-tubercular meningitic hydrocephalus: a preliminary report. Minim Invasive Neurosurg 2005;48:47–52.
7.
Visudhiphan P, Chiemchanya S: Hydrocephalus in tuberculous meningitis in children: treatment with acetazolamide and repeated lumbar puncture. J Pediatr 1979;95:657–660.
8.
Husain M, Jha DK, Rastogi M: Angiographic catheter: unique tool for neuroendoscopic surgery. Surg Neurol 2005;64:546–549.
9.
Jinkins JR, Gupta RK, Chang KH, Rodriguez-Carbajal J: MR imaging of central nervous system tuberculosis. Radiol Clin North Am 1995;33:771–786.
10.
Mishra 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.
11.
Schoeman JF, Van Zyl LE, Laubscher JA, Donald PR: Effect of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis. Pediatrics 1997;99:226–231.
12.
Greitz D: Radiological assessment of hydrocephalus: new theories and implications for therapy. Neurosurg Rev 2004;27:145–165.
13.
Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A: Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 1999;44:795–806.
14.
Palur R, Rajshekhar V, Chandy MJ, Joseph T, Abraham J: Shunt surgery for hydrocephalus in tuberculous meningitis: a long term follow-up study. J Neurosurg 1991;74:64–69.
15.
Lamprecht D, Schoeman J, Donald P, Hartzenberg H: Ventriculoperitoneal shunting in childhood tuberculous meningitis. Br J Neurosurg 2001;15:119–125.
16.
Bullock MMR, van Dellen JR: The role of cerebrospinal fluid shunting in tuberculous meningitis. Surg Neurol 1982;18:274–277.
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