caa a22 4500 606215239 CHVBK 20210128101057.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s00701-015-2501-x doi (NATIONALLICENCE)springer-10.1007/s00701-015-2501-x Rajshekhar Vedantam Department of Neurological Sciences, Christian Medical College Hospital, 632004, Vellore, India aut Surgery for brain tuberculosis: a review [Elektronische Daten] [Vedantam Rajshekhar] The two main manifestations of brain tuberculosis that require surgery are hydrocephalus associated with tuberculous meningitis (TBMH) and brain tuberculomas. TBMH most often responds to medical therapy but surgery is required promptly for those who fail medical therapy. Both ventriculoperitoneal (VP) shunt and endoscopic third ventriculostomy (ETV) are valid options although the latter is more often successful in patients with chronic hydrocephalus than in those with acute meningitis. Patients with TBMH are more prone to complications following VP shunt than other patients. The outcome of these patients is determined by the Vellore grade (I to IV) of the patients prior to surgery with those in good grades (I and II) having a better outcome and those in the worst grade (IV) having a high mortality in excess of 80%. Patients with brain tuberculomas present clinically with features of a brain mass, indistinguishable clinically from other pathologies. CT and MR features might provide a probable diagnosis of a tuberculoma but most often a histological diagnosis is desirable. Empiric medical therapy is reserved for a small number of patients. Although the treatment of brain tuberculomas is essentially medical, surgery is required when the diagnosis is in doubt, to reduce raised intracranial pressure or local mass effect and to obtain tissue for culture and sensitivity studies. Stereotactic biopsy, stereotactic craniotomy and excision of superficial small tuberculomas and microsurgery are all procedures used to manage brain tuberculomas. The outcome in patients with brain tuberculomas is good if the tuberculous bacillus is sensitive to the anti-tuberculous therapy. The duration of therapy is debated but we suggest at least 18months of combination therapy with three or four anti-tuberculous drugs and continue the therapy till the tuberculoma has resolved on neuro-imaging. Springer-Verlag Wien, 2015 Brain nationallicence Meningitis nationallicence Stereotactic surgery nationallicence Surgery nationallicence Tuberculosis nationallicence Tuberculoma nationallicence Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1665-1678 0001-6268 157:10<1665 2015 157 701 https://doi.org/10.1007/s00701-015-2501-x text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 review-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2501-x text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Rajshekhar Vedantam Department of Neurological Sciences, Christian Medical College Hospital, 632004, Vellore, India aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1665-1678 0001-6268 157:10<1665 2015 157 701