title: Modified external ventricular drainage in pediatric tuberculous meningitis: is it possible to avoid ventriculoperitoneal shunt placement?
abstract: OBJECTIVE
  Ventriculoperitoneal shunting is the current mainstay of treatment for children with tuberculous meningitis with hydrocephalus. However, ventriculoperitoneal shunting is highly associated with complications, and more importantly, long-term, indwelling shunt devices may adversely affect children's spirits and psychological health. Therefore, there is clearly a need to explore methods of CSF diversion to avoid ventriculoperitoneal shunting.
  
  
  METHODS
  We studied 6 cases of children with tuberculous meningitis with hydrocephalus in whom external drainage from the ventricle to the subcutaneous abdomen was adopted. Outcomes were assessed over a 6- to 9-month follow-up period based on improvements in radiological features, such as ventricular morphology, as well as the need for ventriculoperitoneal shunting and any complications.
  
  
  RESULTS
  The drainage tubes were removed in 4 cases 4-6 months after the modified external ventricular drainage surgery, and 2 patients went on to receive a ventriculoperitoneal shunt. All patients' CSF protein and cell counts returned to normal, and imaging showed improved ventricular morphology and no intracranial secondary infection.
  
  
  CONCLUSIONS
  In our preliminary study, the modified ventricular drainage device can produce satisfactory outcomes and relatively safe effects and may help some patients to avoid ventriculoperitoneal shunt placement.
authors: Department of Neurosurgery, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, PR China.
authors: Jian
authors: J
authors: Lin
authors: Nu
authors: N
authors: Zhang
authors: Hang-song
authors: HS
authors: Sheng
authors: Mao-de
authors: MD
authors: Wang
authors: Bo
authors: B
authors: Yin
authors: Fen-chun
authors: FC
authors: Lin
mesh_terms: D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000601:surgery*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000453:epidemiology / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects