CENTRAL-NERVOUS-SYSTEM TUBERCULOSIS - MEDICAL-MANAGEMENT AND SURGICALINDICATIONS

BACKGROUND An increase in the incidence of tuberculosis in industriali zed nations has prompted a need for earlier diagnosis, treatment, and isolation of disease. An associated rise in the number of patients wit h central nervous system tuberculosis (CNS TB) has forced neurosurgica l services to reevaluate the indications for operative intervention. M ETHODS Seventeen cases of CNS TB were found in a retrospective review of all cases managed on the neurosurgical service between 1989 and 199 4. These cases included eight with tuberculous meningitis, seven cases of supratentorial tuberculomas, and two cases of infratentorial tuber culomas. RESULTS Major permanent neurologic morbidity was seen in one case (6%). Five patients (29.4%) died of complications associated with their primary disease, Eleven patients (64.6%) had excellent outcomes . All patients in the latter group completed an 18-month course of ant ituberculous therapy. Cerebrospinal fluid shunts were necessary in thr ee cases and emergent craniotomy was performed in three cases, Only fo ur cases had human immunodeficiency virus (HIV) coinfection. CONCLUSIO N The neurosurgeon's role in the management of CNS TB has once again b ecome more evident. In the present series it is unclear as to whether this is due to multiple drug-resistant strains of Mycobacterium tuberc ulosis or HIV coinfection. It is clear, however, that vigilance over p atient compliance and serial neurologic evaluation will determine the need for operative intervention.