title: Endoscopic third ventriculostomy in tubercular meningitis with hydrocephalus.
abstract: BACKGROUND
  Endoscopic third ventriculostomy (ETV) is increasingly being used as an alternative treatment in tubercular meningitis (TBM) hydrocephalus. This study is aimed to evaluate the role of ETV in TBM hydrocephalus.
  
  
  METHODS
  This is a prospective study of 59 patients with TBM and obstructive hydrocephalus. The diagnosis was confirmed by a computed tomography scan and/or magnetic resonance imaging scan preoperatively. The procedure was performed using the standard technique or water jet dissection.
  
  
  RESULTS
  Three (5.1%) patients had blocked stoma, 31 (53%) had associated malnutrition, and 13 (22%) had complex hydrocephalus. Clinical improvement was seen in 34 (58%) after ETV and in 47 (80%) patients after ETV with lumber peritoneal shunt. Thirteen patients with patent stoma and complex hydrocephalus did not improve after ETV alone; an additional lumber peritoneal shunt was required. Clinical outcome was significantly better in good grade. Early recovery was observed in 81%. Results of ETV were better in patients without cisternal exudates, good nutritional status, thin and identifiable floor of third ventricle compared to cases with cisternal exudates, malnourished, thick and unidentifiable floor respectively, although the difference was statistically insignificant. There was no operative death. Three patients with normal ICP did not show any improvement. The radiological recovery after 3 weeks of surgery was 52%; follow-up ranged between 7 and 54 months. Six patients developed CSF leak.
  
  
  CONCLUSIONS
  Endoscopic third ventriculostomy was safe and effective in TBM hydrocephalus. Complex hydrocephalus and associated cerebral infarcts were the major causes of failure to improve. Good results were observed in better grades.
authors.affiliation: Neurosurgery Unit, MP MRI and CT Centre NSCB Medical College, Jabalpur, Madhya Pradesh, India. yadavyr@yahoo.co.in
authors.forename: Yad Ram
authors.initials: YR
authors.lastname: Yadav
authors.forename: Vijay
authors.initials: V
authors.lastname: Parihar
authors.forename: Moneet
authors.initials: M
authors.lastname: Agrawal
authors.forename: Pushp Raj
authors.initials: PR
authors.lastname: Bhatele
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000473:pathology / Q000601:surgery; D007223:Infant; D007427:Intracranial Pressure / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy; D012044:Regression Analysis; D012189:Retrospective Studies; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000000981:diagnostic imaging; D014696:Ventriculostomy / Q000379:methods*; D055815:Young Adult