EVOLUTION OF BRAIN TUBERCULOMAS UNDER STANDARD ANTITUBERCULOUS TREATMENT

The treatment of brain tuberculomas is primarily medical. Surgery, exc ision or biopsy, is generally performed when the diagnosis is in doubt or there is no response to medical therapy. The aim of this study was to determine the radiological evolution of intracranial tuberculomas under standard anti-tuberculous drug therapy and to establish guidelin es for better management of these patients. Eighteen patients were stu died retrospectively. None of them had surgical intervention and all w ere treated by standard antituberculous drugs and had serial computed tomography (CT) scans until disappearance or stabilization of brain le sions. The regression of lesions' size and number was slow in the firs t month (mean -7.3%) then became rapid after this (-15% to -20% per mo nth). A paradoxical increase in size was noted in three patients in th e first month. All three had associated meningitis. All tuberculomas d isappeared on CT scan after 12 months of therapy. Most of the edema im ages disappeared by 6 months. This study would suggest that a long tre atment regimen of 15-18 months may not be necessary in most intracrani al tuberculomas occurring in non-immunocompromised patients. It also d emonstrates that medical trial in well tolerated suspected cases shoul d last for at least 2 months before considering other etiologies or su rgical exploration. (C) 1998 Elsevier Science B.V.