Diagnostic and therapeutic role of CT-guided stereotactic surgery in the management of intracranial tuberculomas.
OBJECTIVE
CT-guided stereotactic methods have long been used for the diagnosis and treatment of intracranial masses. Intracranial tuberculoma is a rare form of extrapulmonary tuberculosis. Histological confirmation is the gold standard for a correct diagnosis. However, histopathological diagnosis and excision of these lesions have advantages over open surgical methods. This study presents our experience on the use of stereotactic biopsy and excision in the management of intracranial tuberculomas.


METHODS
Thirteen patients with intracranial masses underwent stereotactic procedures for tissue samples to establish histopathological diagnosis. In 6 suitable patients, stereotactic microsurgical excision was performed for both diagnostic and therapeutic purposes, whereas only stereotactic biopsy was conducted in the remaining subjects.


RESULTS
The tuberculoma diagnosis was established in 12 out of 13 cases (92%). Seizure control was achieved in all patients admitted with a history of seizures. There was no procedure-related mortality, none of the patients suffered permanent disability and most procedures were uneventful. Total resection without any residual mass was done. All patients responded to antituberculous treatment with complete lesion disappearance.


CONCLUSIONS
These findings suggest that CT-guided stereotactic surgery of intracranial tuberculomas has advantages over other methods, with a potential to become the first-line modality, particularly as a diagnostic tool, in the management of these lesions.
Ersahin
Mehmet
M
Haydarpasa Numune Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey. drmehmetersahin@gmail.com
Hakan
Tayfun
T
Ayan
Erdogan
E
Berkman
Zafer
Z
Ekinci
Osman
O
Ceran
Nurgul
N
Aker
Fugen Vardar
FV
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009044:Motor Cortex / Q000473:pathology; D012640:Seizures / Q000209:etiology; D013238:Stereotaxic Techniques; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D016862:Tuberculoma, Intracranial / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D055815:Young Adult