Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus

Hydrocephalus is one of the commonest complications of tuberculous meningitis (TBM). It can be purely obstructive, purely communicating, or due to combinations of obstruction in addition to defective absorption of cerebrospinal fluid (CSF). Endoscopic third ventriculostomy (ETV) as an alternative to...

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Main Authors:	Yadav, Yad R., Parihar, Vijay S., Todorov, Mina, Kher, Yatin, Chaurasia, Ishwar D., Pande, Sonjjay, Namdev, Hemant
Format:	Online
Language:	English
Published:	Medknow Publications & Media Pvt Ltd 2016
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974953/

id	pubmed-4974953
recordtype	oai_dc
spelling	pubmed-49749532016-10-01 Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus Yadav, Yad R. Parihar, Vijay S. Todorov, Mina Kher, Yatin Chaurasia, Ishwar D. Pande, Sonjjay Namdev, Hemant Review Article Hydrocephalus is one of the commonest complications of tuberculous meningitis (TBM). It can be purely obstructive, purely communicating, or due to combinations of obstruction in addition to defective absorption of cerebrospinal fluid (CSF). Endoscopic third ventriculostomy (ETV) as an alternative to shunt procedures is an established treatment for obstructive hydrocephalus in TBM. ETV in TBM hydrocephalus can be technically very difficult, especially in acute stage of disease due to inflamed, thick, and opaque third ventricle floor. Water jet dissection can be helpful in thick and opaque ventricular floor patients, while simple blunt perforation is possible in thin and transparent floor. Lumbar peritoneal shunt is a better option for communicating hydrocephalus as compared to VP shunt or ETV. Intraoperative Doppler or neuronavigation can help in proper planning of the perforation to prevent neurovascular complications. Choroid plexus coagulation with ETV can improve success rate in infants. Results of ETV are better in good grade patients. Poor results are observed in cisternal exudates, thick and opaque third ventricle floor, acute phase, malnourished patients as compared to patients without cisternal exudates, thin and transparent third ventricle floor, chronic phase, well-nourished patients. Some of the patients, especially in poor grade, can show delayed recovery. Failure to improve after ETV can be due to blocked stoma, complex hydrocephalus, or vascular compromise. Repeated lumbar puncture can help faster normalization of the raised intracranial pressure after ETV in patients with temporary defect in CSF absorption, whereas lumbar peritoneal shunt is required in permanent defect. Repeat ETV is recommended if the stoma is blocked. ETV should be considered as treatment of choice in chronic phase of the disease in obstructive hydrocephalus. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC4974953/ /pubmed/27695532 http://dx.doi.org/10.4103/1793-5482.145100 Text en Copyright: © Asian Journal of Neurosurgery http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Yadav, Yad R. Parihar, Vijay S. Todorov, Mina Kher, Yatin Chaurasia, Ishwar D. Pande, Sonjjay Namdev, Hemant
spellingShingle	Yadav, Yad R. Parihar, Vijay S. Todorov, Mina Kher, Yatin Chaurasia, Ishwar D. Pande, Sonjjay Namdev, Hemant Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus
author_facet	Yadav, Yad R. Parihar, Vijay S. Todorov, Mina Kher, Yatin Chaurasia, Ishwar D. Pande, Sonjjay Namdev, Hemant
author_sort	Yadav, Yad R.
title	Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus
title_short	Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus
title_full	Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus
title_fullStr	Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus
title_full_unstemmed	Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus
title_sort	role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus
description	Hydrocephalus is one of the commonest complications of tuberculous meningitis (TBM). It can be purely obstructive, purely communicating, or due to combinations of obstruction in addition to defective absorption of cerebrospinal fluid (CSF). Endoscopic third ventriculostomy (ETV) as an alternative to shunt procedures is an established treatment for obstructive hydrocephalus in TBM. ETV in TBM hydrocephalus can be technically very difficult, especially in acute stage of disease due to inflamed, thick, and opaque third ventricle floor. Water jet dissection can be helpful in thick and opaque ventricular floor patients, while simple blunt perforation is possible in thin and transparent floor. Lumbar peritoneal shunt is a better option for communicating hydrocephalus as compared to VP shunt or ETV. Intraoperative Doppler or neuronavigation can help in proper planning of the perforation to prevent neurovascular complications. Choroid plexus coagulation with ETV can improve success rate in infants. Results of ETV are better in good grade patients. Poor results are observed in cisternal exudates, thick and opaque third ventricle floor, acute phase, malnourished patients as compared to patients without cisternal exudates, thin and transparent third ventricle floor, chronic phase, well-nourished patients. Some of the patients, especially in poor grade, can show delayed recovery. Failure to improve after ETV can be due to blocked stoma, complex hydrocephalus, or vascular compromise. Repeated lumbar puncture can help faster normalization of the raised intracranial pressure after ETV in patients with temporary defect in CSF absorption, whereas lumbar peritoneal shunt is required in permanent defect. Repeat ETV is recommended if the stoma is blocked. ETV should be considered as treatment of choice in chronic phase of the disease in obstructive hydrocephalus.
publisher	Medknow Publications & Media Pvt Ltd
publishDate	2016
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974953/
_version_	1613622206335549440

Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus

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