Objective: Ventriculoperitoneal shunting is the current mainstay of treatment for children with tuberculous meningitis with hydrocephalus. However, ventriculoperitoneal shunting is highly associated with complications, and more importantly, long-term, indwelling shunt devices may adversely affect children’s spirits and psychological health. Therefore, there is clearly a need to explore methods of CSF diversion to avoid ventriculoperitoneal shunting. Methods: We studied 6 cases of children with tuberculous meningitis with hydrocephalus in whom external drainage from the ventricle to the subcutaneous abdomen was adopted. Outcomes were assessed over a 6- to 9-month follow-up period based on improvements in radiological features, such as ventricular morphology, as well as the need for ventriculoperitoneal shunting and any complications. Results: The drainage tubes were removed in 4 cases 4–6 months after the modified external ventricular drainage surgery, and 2 patients went on to receive a ventriculoperitoneal shunt. All patients’ CSF protein and cell counts returned to normal, and imaging showed improved ventricular morphology and no intracranial secondary infection. Conclusion: In our preliminary study, the modified ventricular drainage device can produce satisfactory outcomes and relatively safe effects and may help some patients to avoid ventriculoperitoneal shunt placement.

Keywords:
Tuberculous meningitis, Hydrocephalus, Outdoor ventricular drainage, Ventriculoperitoneal shunt, Children
1.
Figaji AA, Fieggen AG, Peter JC: Endoscopic third ventriculostomy in tuberculous meningitis. Childs Nerv Syst 2003:19:217–225.
2.
Lamprecht D, Schoeman J, Donald P, Hartzenberg H: Ventriculoperitoneal shunting in childhood tuberculous meningitis. Br J Neurosurg 2001;15:119–125.
3.
Murray HW, Brandstetter RD, Lavyne MH: Ventriculoatrial shunting for hydrocephalus complicating tuberculous meningitis. Am J Med 1981;70:895–898.
4.
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.
5.
Topczewska-Lach E, Lenkiewicz T, Olanski W: Quality of life and psychomotor development after surgical treatment of hydrocephalus. Eur J Pediatr Surg 2005;15:2–5.
6.
Casey ATH, Kimmings EJ, Kleinlugtebeld AD: The long-term outlook for hydrocephalus in childhood – a ten-year cohort study of 155 patients. Pediatr Neurosurg 1997;27: 63–70.
7.
Dennis M, Fitz CR, Netley CT, Sugar J: Impaired motor learning in children with hydrocephalus. Arch Neurol 1981;38:607–615.
8.
Hoppe-Hirsch E, Laroussinie F, Brunet L: Late outcome of the surgical treatment of hydrocephalus. Childs Nerv Syst 1998;14:97–99.
9.
Kokkonen J, Serlo W, Saukkonen AL, Juolasmaa A: Long-term prognosis for children with shunted hydrocephalus. Childs Nerv Syst 1994;10:384–387.
10.
Yadav YR, Parihar V: Management of hydrocephalus in patients with tuberculous meningitis. Neurol Ind 2009;57:691.
11.
Golden MP, Vikram HR: Extrapulmonary tuberculosis: an overview. Am Family Physn 2005;72:1761.
12.
Sil K, Chatterjee S: Shunting in tuberculous meningitis: a neurosurgeon’s nightmare. Childs Nerv Syst 2008;24:1029–1032.
13.
Bhagwati SN: Ventriculoatrial shunt in tuberculous meningitis with hydrocephalus. J Neurosurg 1971;35:309–313.
14.
Bullock MMR, van Dellen JR: The role of cerebrospinal fluid shunting in tuberculous meningitis. Surg Neurol 1982;18:247–274.
15.
Gelabert M, Castro-Gago M: Hydrocephalus and tuberculous meningitis in children. Childs Nerv Syst 1988;4:268–270.
16.
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.
17.
Jonathan A, Rajsekhar V: Endoscopic third ventriculostomy for chronic hydrocephalus after tuberculous meningitis. Surgical Neurol 2005;63:32–35.
18.
Cinalli G: Alternatives to shunting. Childs Nerv Syst 1999;15:718–731.
19.
Fukuhara T, Vorster SJ, Luciano MG: Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurgery 2000;46:1100–1109.
20.
Scarrow AM, Levy EI, Pascucci L, Albright AL: Outcome analysis of endoscopic III ventriculostomy. Childs Nerv Syst 2000;16:442–445.
21.
Schwartz TH, Yoon SS, Cutruzzola FW, Goodman RR: Third ventriculostomy: post-operative ventricular size and outcome. Minim Invasive Neurosurg 1996:39:122–129.
22.
Siomin V, Cinalli G, Grotenhuis A, Golash A: Endoscopic third ventriculostomy in patients after cerebrospinal fluid infection and/or hemorrhage. J Neurosurg 2002;97:519–524.
23.
Gupta RK, Gupta S, Singh D: MR imaging and angiography in tuberculous meningitis. Neuroradiology 1994;36:87–92.
24.
Gupta RK, Kathuria MK, Pradhan S: Magnetization transfer MR imaging in CNS tuberculosis. Am J Neuroradiol 1999;20:867–875.
25.
Jinkins JR, Gupta RK, Chang KH, Rodriguez-Carbajal J: MR imaging of central nervous system tuberculosis. Radiol Clin N Am 1995;33:771–786.
26.
Kamra P, Azad R, Prasad KN: Infectious meningitis: prospective evaluation with magnetization transfer MRI. Br J Radiol 2004;77:387–394.
27.
Kumar R, Singh SN, Kohli N: A diagnostic rule for tuberculous meningitis. Arch Dis Child 1999;81:221–224.
28.
Thomas MD, Copra JS, Banerjee AK, Singh MS: Tuberculous meningitis: a clinicopathological study. Neurol Ind 1997:25:26–34.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.