title: Role of ventriculoperitoneal shunt surgery in grade IV tubercular meningitis with hydrocephalus.
abstract: OBJECTIVE
  Hydrocephalus is a common complication of tuberculous meningitis (TBM) in children. The role of ventriculoperitoneal shunt (VPS) placement in grade IV patients is controversial. The aim of this study is to investigate the clinical value of VPS placement for patients with grade IV TBM with hydrocephalus (TBMH).
  
  
  METHODS
  This study was carried out on children with grade IV TBMH from January 2006 to January 2011 in Xiangya Hospital, China. All patients were given VPS placement combined with medicine treatment. External ventricular drainage (EVD) was performed only in the presence of severe biochemical derangements or brainstem dysfunction requiring correction before shunt surgery. Outcomes were divided into normal, mild sequelae, severe sequelae, death, or vegetable status.
  
  
  RESULTS
  A total of 19 children with grade IV TBMH were recruited into the study. The average follow-up period was 29 months. Three of the 19 patients expired, four patients had a full recovery, eight had slight sequelae, and four had severe sequelae. Six complications related to the shunt surgery were seen among the patients.
  
  
  CONCLUSIONS
  This study demonstrates that direct ventriculoperitoneal shunt surgery could improve the outcome of grade IV TBMH. The response to EVD is not a reliable indication for selecting patients who would benefit from shunt surgery.
authors: Department of Pediatrics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, Hunan, People's Republic of China.
authors: Jing
authors: J
authors: Peng
authors: Xiaolu
authors: X
authors: Deng
authors: Fang
authors: F
authors: He
authors: Ahmed
authors: A
authors: Omran
authors: Ciliu
authors: C
authors: Zhang
authors: Fei
authors: F
authors: Yin
authors: Jingping
authors: J
authors: Liu
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D007223:Infant; D008297:Male; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000473:pathology / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt