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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(04): 685-692
DOI: 10.1055/s-0044-1788987
Original Article

Calvarial Tuberculosis: Shifting Paradigm from Surgical to Conservative Approach

Vivek Kumar
1   Department of Neurosurgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
,
Varun Aggarwal
1   Department of Neurosurgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
,
Gopal Krishna
1   Department of Neurosurgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
,
Ishwar Singh
1   Department of Neurosurgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
,
Vinay Vinay
2   Department of Community Medicine, Post Graduate Institute of Medical Sciences Rohtak, Rohtak, Haryana, India
,
Praveen S. Holkar
1   Department of Neurosurgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Abstract

Background Tuberculosis (TB) is an endemic disease in developing countries like India. However, incidence of calvarial TB is very low and it presents in varied forms posing a diagnostic dilemma and delay in management.

Objective This article reports a case series of 15 patients with varied presentations of calvarial TB from a tertiary care superspeciality center of Haryana state in India.

Materials and Methods Study is a retrospective analysis of 15 patients with calvarial TB treated between 2018 and 2021 in a tertiary care hospital. Clinical features, radiological findings, surgical and medical management, and outcomes were reviewed.

Results Of the 15 patients, 9 were males and age ranged between 12 and 45 years. Mean duration of symptoms was 2.9 months (range 1–5 months). The most common presenting symptoms were scalp swelling, discharging sinus, and pain. Four patients were treatment defaulters of pulmonary TB and two patients were found human immunodeficiency virus positive. Brain imaging showed peripherally enhancing extradural collection with bone erosions in most cases. Eleven patients were managed conservatively with fine-needle aspiration cytology (FNAC) or local debridement/sinus excision. Four patients were managed surgically with drainage of collection, excision of necrotic bone, followed by antitubercular therapy. One patient needed cerebrospinal fluid diversion for associated hydrocephalous with tubercular meningitis which could not recover and succumbed.

Conclusion Calvarial TB is a rare occurrence of common prevalent diseases. Conservative management with FNAC and sinus excision followed by antitubercular treatment are the mainstay of treatment. Surgery should be reserved for extensive lesion or lesion with mass effect.

Keywords

calvarial tuberculosis - antitubercular therapy

Authors' Contributions

V.A., G.K., and I.S. made significant contributions to the conception and design of the study. V. was responsible for the acquisition of data, as well as the analysis and interpretation of the data. P.S.H. also contributed to the acquisition of data and participated in the analysis and interpretation of the data.




Publication History

Article published online:
09 August 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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