CT-GUIDED STEREOTAXIC SURGERY IN THE MANAGEMENT OF INTRACRANIAL TUBERCULOMAS

CT-guided stereotactic techniques were used in the management of 21 pa tients (22 procedures) with intra tuberculomas. In 17 patients CT-guid ed stereotactic surgery was performed to obtain a diagnosis; 10 patien ts with small superficial lesions or masses in eloquent areas had an e xcision biopsy following CT-guided stereotactic craniotomies (Group A) ; seven patients underwent a closed stereotactic biopsy (Group B). Fou r patients (five procedures) with previously proven tuberculous diseas e had stereotactic aspiration of a cystic tuberculous mass (Group C). All patients in Group A had a definite histological diagnosis of a tub erculoma. Of the seven in Group B, a definitive diagnosis was obtained in two; in four patients the biopsy showed evidence of chronic inflam mation; and in one the procedure was abandoned due to venous hemorrhag e. All patients in Group C had amelioration of their symptoms followin g aspiration of the contents of the cystic mass. There was transient o perative morbidity in two patients. There was no procedure-related per manent disability or mortality. CT-guided stereotactic biopsy being mi nimally invasive, is ideally suited for the management of deep-seated intracranial tuberculomas as they can be treated medically once a diag nosis is secured. A diagnosis of chronic inflammation obtained on CT-g uided stereotactic biopsy, in correlation with the clinical and radiol ogical findings, often provides confirmatory evidence of a tuberculoma in a patient with an intracranial mass. It also rules out a neoplasm and avoids empiric therapy of brain masses. Stereotactic localization techniques also help avoid possible morbidity associated with the exci sion of superficial small tuberculomas from eloquent areas.