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- Title
Outcome of ventriculoperitoneal shunting in children with poor grade Tubercular Meningitis with Hydrocephalus.
- Authors
Jagadeesh, V. M.; Paritosh, P.; Rojin, G. A.; Devi, B. Indira; Sampath, S.; Chandramouli, B. A.
- Abstract
INTRODUCTION: The role of VP shunt in grade IV tubercular meningitis with hydrocephalus(TBM with HC) is controversial, with majority opining against the use of the same. To summarize our institutional experience in this regard, we have looked retrospectively into pediatric patients with grade IV TBM with HC, who have been treated with ventriculoperitoneal shunt(VPS), and assessed their outcome. MATERIALS AND METHODS: Case reports of 57 consecutive pediatric(<l4yrs) cases of Grade IV(GCS<8) TBM with HC who underwent VPshunt at NIMHANS between Jan 2000 & Dec 2005, were retrospectively analyzed. VPshunt was done in almost all cases with hydrocephalus. An EVD placement(39%) was done only in instances where patient had deranged blood parameters. All patients were given 4-drug anti-tuberculous therapy with steroids. Outcome was assessed in terms of GCS at discharge and follow up. RESULTS: The mean age at presentation was 4.2 years. The median duration of symptoms and duration of altered sensorium prior to intervention were 18.5 days and 3 days, respectively. Infarcts were present in 20(35%) of patients on pre-op CT scan. Following VPS, 47% of patients improved by >2 points in their GCS, 40% of the patients remained status quo or improved by <2 points, and the rest deteriorated. Five patients expired following surgery. Follow-up was available in 13 (25%) patients. The median follow-up was 8 months, and the median GCS at follow up was 14. Age and duration of symptoms did not correlate with outcome. Presence of basal exudates on CT scan had a higher incidence of the patient developing an infarct. A lower GCS at presentation (<6) and a longer duration of altered sensorium prior to intervention (>72 hours) were indicators of a poorer outcome (GCS<8 at discharge) (P=0.07 & 0.02, respectively). There were no significant differences in outcome between patients who underwent EVD placement prior to VP shunt, and those who did not. CONCLUSION: Shunt is an effective option in Grade IV tubercular TBM with HC. Prior placement of EVD may not necessary for majority of these patients. GCS at presentation and duration of altered sensorium prior to intervention sue related to outcome.
- Subjects
PERITONEOVENOUS shunts; MENINGITIS in children; HYDROCEPHALUS in children; ANTITUBERCULAR agents; HEALTH outcome assessment
- Publication
Journal of Pediatric Neurosciences, 2007, Vol 2, Issue 2, p98
- ISSN
1817-1745
- Publication type
Article