Abstract
Introduction To date, there are no standard practice guidelines available and no universal consensus
regarding treatment protocol in management of tuberculous meningitis (TBM) with hydrocephalus.
Over the years, diverse views have existed in neurosurgical management of TBM with
hydrocephalus. Some authors advocate ventriculo-peritoneal (VP) shunt, while others
suggest that external ventricular drainage (EVD) may be the preferable neurosurgical
procedure for a poor-grade patient.
Method We systematically reviewed published literature and presented our institution's experience.
We performed a retrospective case study in our Sarawak neurosurgical center from 2018
to 2020. We tabulated the outcome according to preoperative classifications, which
were Vellore Grading (VG), Modified Vellore Grading (MVG), British Medical Research
Council Classification (MRC), and others: author-defined.
Result In our center, there were 20 cases of TBM with hydrocephalus treated by EVD and VP
shunt from 2018 to 2020. We systematically searched published medical literature,
and 23 articles were retrieved and analyzed. Poor outcomes were observed in poor-grade
patients, especially VG/MVG 3/4 and MRC 3, from both institution and systemic review
data. Shunt complication rate was lower in our center as compared with published literature.
Conclusion Unfortunately, morbidity and mortality were approximately twofold higher in poor-grade
as compared with good-grade patients. However, about one-third of poor-grade patients
achieved a good outcome. Cerebrospinal fluid (CSF) diversion would be an unavoidable
treatment for hydrocephalus. Poor-grade patients tend to have cerebral infarcts in
addition to hydrocephalus. An extended duration of EVD placement could be a potential
measure to assess Glasgow coma scale recovery and monitor serial CSF samples.
Keywords
tuberculous meningitis - hydrocephalus - EVD - VP shunt
