Shunt surgery in poor grade patients with tuberculous meningitis and hydrocephalus: effects of response to external ventricular drainage and other variables on long term outcome

Mathew, John; Rajshekhar, Vedantam; Chandy, Mathew J.

doi:10.1136/jnnp.65.1.115

Cited by 60 publications

(56 citation statements)

References 7 publications

(5 reference statements)

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“…Although some studies do not advocate surgical intervention among patients with a Vellore score of 4, there are also some studies showing benefit among these patients. [3,5,[10][11][12][13] Moreover, this study has also shown that an increase in the scores of eyeopening (E) and verbal output (V) components of the GCS score confers a multiplicative decrease in the probability of considering surgery. Higher E and V scores signify a better sensorium as seen in patients with a Vellore score of 1, where the majority of patients were given medical management.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with a Vellore score of 1-3 should be offered immediate surgery while Grade 4 may have a trial with an external ventricular drainage (EVD) first before having a shunt surgery to see if they would respond to it since these patients are already deemed to respond poorly to surgery. [3,5,[10][11][12][13] Moreover, CSF characteristics on lumbar tap were also chosen in the construction of the mathematical model since they are also found to be significant factors by other studies, especially the polymorphonuclear cell count, protein count, as well, the opening pressure (OP). [2,7,12] The other two commonly used parameters -radiographic evidence of the severity of hydrocephalus and the response to trial with an EVD -were not used in the development of our model since these are not commonly done in our institution.…”

Section: Symptoms Consistent With Hydrocephalus (Persistent Headache mentioning

confidence: 99%

“…Finally, since clinical deterioration is avoided by offering immediate surgical intervention to those who will likely benefit from it, the pre-operative clinical condition of the patient is optimized, especially that this is the single most important predictor of good outcome postoperatively. [12] …”

Section: Premises Of the Modelmentioning

confidence: 99%

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A mathematical approach in the management of hydrocephalus from tuberculous meningitis

Saranza¹,

Sumalapao²,

Batara³

et al. 2017

Natl J Physiol Pharm Pharmacol

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Background:The unavailability of standardized treatment algorithms to properly select tuberculous meningitis (TBM) patients for surgery delays optimal management. Aim and Objective: This study developed a mathematical model as an objective guide in deciding whether to perform surgical intervention or not among patients with hydrocephalus from TBM. Materials and Methods: Using 13 different clinical and cerebrospinal fluid parameters, a saturated logistic regression model was developed and tried retrospectively on 37 previously managed cases of hydrocephalus from TBM. Results: The model is statistically significant (P = 0.0170) with 93.2% concordance index in predicting physician's decision on admission whether the patient will undergo surgical intervention or not. Patients are recommended for surgical intervention if g-score >0.04 with 90.48% sensitivity. Conclusion: With its significant P-value and high concordance index, the model is a good representative of the actual decision making of physicians in the management of hydrocephalus from TBM.

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Section: Discussionmentioning

confidence: 99%

Section: Symptoms Consistent With Hydrocephalus (Persistent Headache mentioning

confidence: 99%

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A mathematical approach in the management of hydrocephalus from tuberculous meningitis

Saranza¹,

Sumalapao²,

Batara³

et al. 2017

Natl J Physiol Pharm Pharmacol

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“…It has been stated that early ventricular shunting leads to a favorable outcome [4, 6, 8]; however, this has not been proven statistically. In fact, the studies performed on patients with TBM complicated by hydrocephalus are relatively few in number [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. …”

Section: Introductionmentioning

confidence: 87%

“…Although shunt surgery has been recommended for the treatment of TBM with hydrocephalus, using this procedure in the treatment of hydrocephalus does not consistently result in favorable outcomes [5, 6]. …”

Section: Introductionmentioning

confidence: 99%

Timing of Shunt Surgery in Childhood Tuberculous Meningitis with Hydrocephalus

Kemaloğlu¹,

Özkan²,

Bükte

et al. 2002

Pediatr Neurosurg

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Hydrocephalus is a common complication of tuberculous meningitis (TBM) in children. The aims of this study are to review our experience of hydrocephalus in childhood TBM and to evaluate the effect of the timing of ventriculoperitoneal shunting (VPS) on the final outcome. In this study, 156 patients with TBM and hydrocephalus were reviewed retrospectively between 1990 and 2000. Patients’ ages ranged from 6 months to 15 years, with a mean age of 4.1 years. There were 85 boys, and the male-to-female ratio was 1.19:1.0. Sixty-two percent of the children were younger than 6 years old. VPS was performed 2 days after the diagnosis in 100 patients, and in the remaining 56 patients, 3 weeks after the diagnosis. The average follow-up period was 8.5 months. Good recovery or minor sequelae was seen in 82 patients (52.6%), and 51 died (12.3%). The timing of the VPS procedure and cerebral complications had an effect on the final outcome. Early VPS gave a better outcome in mild and moderate hydrocephalus (p = 0.040). This study has shown that early surgical procedure for mild/moderate hydrocephalus has a positive effect on the morbidity and mortality of hydrocephalus in childhood TBM (p = 0.014, p = 0.040, respectively). In severe hydrocephalus, there was a tendency for early shunting to have a positive effect on morbidity, although this did not reach statistical significance.

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Six months therapy for tuberculous meningitis

Jullien¹,

Ryan

Modi

et al. 2016

Cochrane Database of Systematic Reviews

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BackgroundTuberculous meningitis (TBM) is the main form of tuberculosis that affects the central nervous system and is associated with high rates of death and disability. Most international guidelines recommend longer antituberculous treatment (ATT) regimens for TBM than for pulmonary tuberculosis disease to prevent relapse. However, longer regimens are associated with poor adherence, which could contribute to increased relapse, development of drug resistance, and increased costs to patients and healthcare systems.ObjectivesTo compare the effects of short-course (six months) regimens versus prolonged-course regimens for people with tuberculous meningitis (TBM).Search methodsWe searched the following databases up to 31 March 2016: the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; EMBASE; LILACS; INDMED; and the South Asian Database of Controlled Clinical Trials. We searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov for ongoing trials. We also checked article reference lists and contacted researchers in the field.Selection criteriaWe included randomized controlled trials (RCTs) and prospective cohort studies of adults and children with TBM treated with antituberculous regimens that included rifampicin for six months or longer than six months. The primary outcome was relapse, and included studies required a minimum of six months follow-up after completion of treatment.Data collection and analysisTwo review authors (SJ and HR) independently assessed the literature search results for eligibility, and performed data extraction and 'Risk of bias' assessments of the included studies. We contacted study authors for additional information when necessary. Most data came from single arm cohort studies without a direct comparison so we pooled the findings for each group of cohorts and presented them separately using a complete-case analysis. We assessed the quality of the evidence narratively, as using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was inappropriate with no direct comparisons between short- and prolonged-course regimens.Main resultsFour RCTs and 12 prospective cohort studies met our inclusion criteria, and included a total of 1881 participants with TBM. None of the included RCTs directly compared six months versus longer regimens, so we analysed all data as individual cohorts to obtain relapse rates in each set of cohorts.We included seven cohorts of participants treated for six months, with a total of 458 participants. Three studies were conducted in Thailand, two in South Africa, and one each in Ecuador and Papua New Guinea between the 1980s and 2009. We included 12 cohorts of participants treated for longer than six months (ranging from eight to 16 months), with a total of 1423 participants. Four studies were conducted in India, three in Thailand and one each in China, South Africa,...

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Shunt surgery in poor grade patients with tuberculous meningitis and hydrocephalus: effects of response to external ventricular drainage and other variables on long term outcome

Cited by 60 publications

References 7 publications

A mathematical approach in the management of hydrocephalus from tuberculous meningitis

A mathematical approach in the management of hydrocephalus from tuberculous meningitis

Timing of Shunt Surgery in Childhood Tuberculous Meningitis with Hydrocephalus

Six months therapy for tuberculous meningitis

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