title: Factors affecting the outcome of neuroendoscopy in patients with tuberculous meningitis hydrocephalus: a preliminary study.
abstract: BACKGROUND
  In recent years, ETV has been found to be effective in patients with TBMH; however, its precise selection criteria are yet to be established. We carried out this study to identify the factors affecting the outcome of ETV in TBMH.
  
  
  METHODS
  Fourteen patients with TBMH (11 male patients and 3 female patients; mean age, 15.7 years; range, 9 months to 40 years) formed the study group. Various preoperative (clinical grade, ventricular morphology, basal exudates, and CNS tuberculoma) and perioperative (ependymal tubercles, third ventricular floor anatomy, exudates, and adhesions) factors were studied with regard to the result of ETV. Endoscopic third ventriculostomy could be performed on 13 patients; however, an unidentifiable third ventricular floor anatomy precluded ETV in the remaining patient. Endoscopic third ventriculostomy was assigned as "failed" if the patient needed shunt, required EVD, or died in the postoperative period. The average follow-up period for the patients was 5 months.
  
  
  RESULTS
  Endoscopic third ventriculostomy was successful in 9 of the 14 (64.2%) patients subjected to neuroendoscopy. Statistical analysis did not show any significant association of ventricular morphology (P = .109), basal enhancement on CT (P = .169), CNS tuberculoma (P = .169), and clinical grade (P = .057) with the result of ETV, probably because of the small number of cases. However, patients with severe hyponatremia, extra-CNS tuberculosis, an unidentifiable third ventricular floor anatomy, and adhesions in the prepontine cistern had a failed ETV. Patients with tuberculoma in the brain had a successful ETV.
  
  
  CONCLUSIONS
  Endoscopic third ventriculostomy is likely to fail in the presence of advanced clinical grade, extra-CNS tuberculosis, dense adhesions in prepontine cisterns, and an unidentifiable third ventricular floor anatomy. Tuberculoma in the brain in cases of TBMH may be associated with a successful ETV.
authors.affiliation: Department of Neurosurgery, St Stephens Hospital, Tishazari, Delhi 110054, India. jhadeepak2@rediffmail.com
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Jha
authors.forename: Vineeta
authors.initials: V
authors.lastname: Mishra
authors.forename: Ajay
authors.initials: A
authors.lastname: Choudhary
authors.forename: Prakash
authors.initials: P
authors.lastname: Khatri
authors.forename: Rajiv
authors.initials: R
authors.lastname: Tiwari
authors.forename: Anuradha
authors.initials: A
authors.lastname: Sural
authors.forename: Sushil
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D001927:Brain Diseases / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D007010:Hyponatremia / Q000150:complications; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D044583:Neuroendoscopy / Q000009:adverse effects / Q000401:mortality; D011149:Pons; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D000267:Tissue Adhesions / Q000150:complications; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome; D016862:Tuberculoma, Intracranial / Q000150:complications; D014376:Tuberculosis / Q000150:complications; D014390:Tuberculosis, Meningeal / Q000150:complications*; D014696:Ventriculostomy / Q000009:adverse effects / Q000401:mortality