Management of post-tubercular hydrocephalus.

PURPOSE: Tubercular meningitis can lead to hydrocephalus which is a challenging condition to treat in this setting. There is no consensus on treatment protocols for this condition. We have reviewed the literature and formulated treatment guidelines based on available literature and our own experience. OBSERVATIONS: The main available options for management of tubercular hydrocephalus are conservative medical therapy, ventriculoperitoneal shunt and endoscopic third ventriculostomy (ETV). There is no universal consensus regarding the treatment protocol. However, decision regarding the best treatment should be based on the clinical condition of the patient, presence or absence of meningitis, duration of the disease, communicating or non- communicating hydrocephalus, socioeconomic condition of the patient, surgeons expertise, availability of resources for endoscopy. We have given a treatment algorithm for treatment of these patients which can help in protocol-based management of such cases.
CONCLUSION: Tubercular basal meningitis is a medical problem with limited role of neurosurgery except when patient develops hydrocephalus. Management of hydrocephalus in this condition is challenging and fraught with a myriad of complications. Ventriculoperitoneal shunt is an ideal option of vast majority of patients. However, in case of availability of endoscopic facility and expertise, ETV can be an option in selected group of patients. Our algorithm for management can help a clinician to objectively assess the patient and decide on a protocol-based management.