The changing face of tuberculomas.

Tuberculomas of the brain continue to be prevalent in all the developing countries of Asia, Africa, South American and Europe and seem to be making a comeback in the richer nations of the West. They pose a challenge to the neurosurgeon, in spite of the advances that have been made in the diagnosis of these lesions and in the available therapeutic regimes. During the last decade, computed tomographic (CT) scan has facilitated early diagnosis of tuberculomas at a stage when the lesions are small and antituberculous therapy (ATT) has been found beneficial in the majority of patients. Those lesions that do not respond need change in the ATT regimen and addition of steroids. Some lesions tend to disappear by themselves after a few weeks and probably are not tuberculous in nature. Some continue to grow in spite of ATT, probably due to drug resistance and require surgery, and some turn out to be gliomas. As it is not possible to differentiate between glioma or tuberculoma from CT morphology alone, and as stereotactic biopsy can be expensive, it is worth a trial with ATT, reserving surgery only to those which continue to grow inspite of ATT.