OBJECTIVE: This study aims at generating knowledge to understand the conditions in which either of the two procedures (endoscopic third ventriculostomy (ETV) and shunt) are better options and to develop good practice guidelines for the treatment of tubercular meningitis (TBM) hydrocephalus. METHODS: This study was conducted on 48 patients in pediatric age group (less than or equal to 18 years) of TBM hydrocephalus. The patients were randomized to one of the cerebrospinal fluid diversion procedures (ETV or shunt). The two procedures were compared for their outcome, both radiologically and clinically. RESULTS: Twenty-four cases underwent shunt, out of which 13 (68%) cases were successful. Twelve (70.3%) cases belonged to grade 3, while one case was of grade 1. In ETV group, 10 (42%) cases had a successful outcome, out of which 7 (38.8%) cases were in grade 3, while 1 case each belonged to grades 1, 2, and 4. Incidence of ETV failure was more in younger age group, i.e., <2 years (n = 7), while no such correlation with age was found in shunt cases. CONCLUSION: Though with the present study it looks like that the relative risk of ETV failure is higher than that for shunt, but the risk becomes progressively lower with time. Therefore, if patients survive the early high-risk period, they could experience a long-term survival advantage devoid of life-long shunt-related complications. Though for definitive comparison, a long-term study is needed.
RCT Entities:
OBJECTIVE: This study aims at generating knowledge to understand the conditions in which either of the two procedures (endoscopic third ventriculostomy (ETV) and shunt) are better options and to develop good practice guidelines for the treatment of tubercular meningitis (TBM) hydrocephalus. METHODS: This study was conducted on 48 patients in pediatric age group (less than or equal to 18 years) of TBM hydrocephalus. The patients were randomized to one of the cerebrospinal fluid diversion procedures (ETV or shunt). The two procedures were compared for their outcome, both radiologically and clinically. RESULTS: Twenty-four cases underwent shunt, out of which 13 (68%) cases were successful. Twelve (70.3%) cases belonged to grade 3, while one case was of grade 1. In ETV group, 10 (42%) cases had a successful outcome, out of which 7 (38.8%) cases were in grade 3, while 1 case each belonged to grades 1, 2, and 4. Incidence of ETV failure was more in younger age group, i.e., <2 years (n = 7), while no such correlation with age was found in shunt cases. CONCLUSION: Though with the present study it looks like that the relative risk of ETV failure is higher than that for shunt, but the risk becomes progressively lower with time. Therefore, if patients survive the early high-risk period, they could experience a long-term survival advantage devoid of life-long shunt-related complications. Though for definitive comparison, a long-term study is needed.
Authors: Suzaan Marais; Guy Thwaites; Johan F Schoeman; M Estée Török; Usha K Misra; Kameshwar Prasad; Peter R Donald; Robert J Wilkinson; Ben J Marais Journal: Lancet Infect Dis Date: 2010-09-06 Impact factor: 25.071
Authors: Andre Marolop Pangihutan Siahaan; Steven Tandean; Rr Suzy Indharty; Bahagia Willibrodus Maria Nainggolan; Martin Susanto Journal: Int J Surg Case Rep Date: 2022-09-08
Authors: Elizabeth W Tucker; Suzaan Marais; James A Seddon; Reinout van Crevel; Ahmad Rizal Ganiem; Rovina Ruslami; Wenhong Zhang; Feng Sun; Xian Zhou; Regan S Solomons; Fiona V Cresswell; Jo Wilmshurst; Ursula Rohlwink Journal: Open Forum Infect Dis Date: 2020-09-23 Impact factor: 3.835