Changing concepts in the treatment of tuberculomas of the brain.

Tuberculomas of the brain in children constitute 5% to 8% of intracranial space-occupying lesions in developing countries. These have in the past been treated with antituberculous drugs and with excision of large masses when the intracranial tension was high. Computed tomography (CT) has modified this approach. CT has resulted in earlier diagnosis and has been of help in monitoring the results of medical treatment of tuberculomas in children. With such monitoring there has been less need for surgical excision. At the same time, it has been realised that some caution is required towards our dependence on CT, as the image morphology of a tuberculoma could simulate other lesions like a glioma, and surgical excision needs to be carried out when in doubt or when there is no appreciable improvement in CT appearances with medical treatment.