A randomized study of ventriculoperitoneal shunt versus endoscopic third ventriculostomy for the management of tubercular meningitis with hydrocephalus.
OBJECTIVE
This study aims at generating knowledge to understand the conditions in which either of the two procedures (endoscopic third ventriculostomy (ETV) and shunt) are better options and to develop good practice guidelines for the treatment of tubercular meningitis (TBM) hydrocephalus.


METHODS
This study was conducted on 48 patients in pediatric age group (less than or equal to 18 years) of TBM hydrocephalus. The patients were randomized to one of the cerebrospinal fluid diversion procedures (ETV or shunt). The two procedures were compared for their outcome, both radiologically and clinically.


RESULTS
Twenty-four cases underwent shunt, out of which 13 (68%) cases were successful. Twelve (70.3%) cases belonged to grade 3, while one case was of grade 1. In ETV group, 10 (42%) cases had a successful outcome, out of which 7 (38.8%) cases were in grade 3, while 1 case each belonged to grades 1, 2, and 4. Incidence of ETV failure was more in younger age group, i.e., <2 years (n = 7), while no such correlation with age was found in shunt cases.


CONCLUSIONS
Though with the present study it looks like that the relative risk of ETV failure is higher than that for shunt, but the risk becomes progressively lower with time. Therefore, if patients survive the early high-risk period, they could experience a long-term survival advantage devoid of life-long shunt-related complications. Though for definitive comparison, a long-term study is needed.
Department of Neurosurgery, King George's Medical University, Lucknow, India.
Pawan
P
Goyal
Chhitij
C
Srivastava
Bal Krishna
BK
Ojha
Sunil K
SK
Singh
Anil
A
Chandra
R K
RK
Garg
Swati
S
Srivastava
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012720:Severity of Illness Index; D020542:Third Ventricle / Q000601:surgery*; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt / Q000379:methods*; D014696:Ventriculostomy / Q000379:methods*