Brain biopsy in tuberculoma: the risks and benefits.
In developing countries, 5 to 8% of the space-occupying lesions of the central nervous system are tuberculomas. Diagnosis can be difficult in the absence of extracranial tuberculosis; computed tomography is suggestive only. To assess the value of brain biopsies in tuberculomas, the records of 15 patients aged 6 to 80 years were reviewed. Histological confirmation was obtained in 15 patients, and acid-fast bacilli were cultured from 12 patients. Intracranial hypertension was the principal sign in 11 patients; other neurological signs were related to the location of the tuberculoma. One patient had evidence of extracranial tuberculosis. Biopsy-related complications consisted of an epidural hematoma in 1 patient and hydrocephalus in another; both required additional surgery. One case of tuberculous meningitis was probably related to surgery and poor drug compliance. There was no postoperative mortality. Thirteen patients (2 were lost to follow-up) were cured after an average of 16 months of antituberculous therapy. It was concluded that the brain biopsy is useful in diagnosing tuberculoma but that there is some associated risk.
Bouchama
A
A
Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
al-Kawi
M Z
MZ
Kanaan
I
I
Coates
R
R
Jallu
A
A
Rahm
B
B
Siqueira
E B
EB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects; D001927:Brain Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014375:Tuberculoma / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D014390:Tuberculosis, Meningeal / Q000209:etiology