Endoscopic third ventriculostomy in prepontine-suprasellar tuberculoma with tuberculous meningitis hydrocephalus: a case report.
We present a case of prepontine-suprasellar tuberculoma involving the premamillary region of the third ventricular floor, a site suitable to perform an endoscopic third ventriculostomy (ETV) stoma, managed endoscopically, and discuss our findings. A 5-year-old male child was admitted in an unconscious state with a history of gradually progressive symptoms of raised intracranial pressure and low-grade fever for the last 3 months. Head computed tomography showed thick enhancing basal exudates, a prepontine-suprasellar ring-enhancing lesion with consequent obstructive hydrocephalus. The child was subjected to urgent endoscopy which revealed multiple ependymal tubercles along with prepontine-suprasellar tuberculoma involving the premamillary region of the third ventricular floor. The tuberculoma was decompressed using a 5-french catheter, and ETV was performed. Postoperatively, the child improved clinicoradiologically on antitubercular chemotherapy and needed no further cerebrospinal fluid diversion surgery; he is under regular follow-up. We conclude that ETV may be attempted even in the presence of thick basal exudates and/or prepontine-suprasellar tuberculoma.
Jha
Deepak
D
Department of Neurosurgery, St. Stephens Hospital, Tishazari, Delhi, India. jhadeepak2@rediffmail.com
Khatri
Prakash
P
Choudhary
Ajay
A
Sethi
Rajeev
R
Kumar
Sushil
S
D001933:Brain Stem; D002675:Child, Preschool; D006801:Humans; D006849:Hydrocephalus / Q000382:microbiology; D008297:Male; D044583:Neuroendoscopy; D016862:Tuberculoma, Intracranial / Q000150:complications / Q000601:surgery*; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000601:surgery*; D014696:Ventriculostomy / Q000379:methods*