Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 57, Num. 5, 2009, pp. 691-691

Neurology India, Vol. 57, No. 5, September-October, 2009, pp. 691

Correspondence

Management of hydrocephalus in patients with tuberculous meningitis

Y. R. Yadav, Vijay Parihar

Neuro Surgery Unit, NSCB Medical College Jabalpur, MP - 482 003, India.

Correspondence Address: Neuro Surgery Unit, NSCB Medical College Jabalpur, MP - 482 003, India.
yadavyr@yahoo.co.in

Date of Acceptance: 06-Oct-2009

Code Number: ni09200

PMID: 19934588

DOI: 10.4103/0028-3886.57783

To the Editor: We read Prof. Rajshekhar's article ^[1] with interest. It is a very well written and quite informative. He has rightly mentioned that hydrocephalus is very common in tubercular meningitis (TBM). We have few comments regarding types of hydrocephalus and modes of treatments. Author has mentioned only two types of hydrocephalus (Obstructive and Communicating), while hydrocephalus in TBM could be purely obstructive, purely communicating or due to combinations of pathologies (obstruction in addition to defective absorption). ^[2],[3] Patients with combination of pathologies (complex hydrocephalus) could result in failure of ETV in spite of a patent stoma. Author has also mentioned that the success rate of endoscopic third ventriculostomy (ETV) in TBM is low. This is because of high incidence (28%) of complex hydrocephalus in this group. ^[2] Lumbar peritoneal (LP) shunt is effective in failed ETV cases in TBM hydrocephalus where stoma is patent. ^[2] Communicating hydrocephalus is more common than obstructive hydrocephalus or hydrocephalus due to combination of pathologies. Author has also agreed that communicating hydrocephalus is more common in TBM, while he has not mentioned lumbar peritoneal shunt as a treatment option at all. Lumbar peritoneal shunt is a better alternative in communicating hydrocephalus than ventriculo-peritoneal shunt. ^[4],[5] Lumbar peritoneal shunt has the advantage of being an entirely extracranial operation.

References

1.	Rajshekhar V. Management of hydrocephalus in patients with tuberculous meningitis. Neurol India 2009;57:368-74.  Back to cited text no. 1  [PUBMED]
2.	Yadav YR, Mukerji G, Parihar V, Sinha M, Pandey S. Complex hydrocephalus: a0 n important cause of failed endoscopic third ventriculostomy. BMC Res Notes 2009;2:137.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.	Beni-Adani L, Biani N, Ben-Sirah L, Constantini S. The occurrence of obstructive vs absorptive hydrocephalus in newborns and infants: r0 elevance to treatment choices. Childs Nerv Syst 2006;22:1543-63.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.	Yadav YR, Pande S, Raina VK, Singh M. Lumboperitoneal shunts: r0 eview of 409 cases. Neurol India 2004;52:188-90.  Back to cited text no. 4  [PUBMED]
5.	Aoki N. Lumboperitoneal shunt: clinical applications, complications, and comparison with ventriculoperitoneal shunt. Neurosurgery 1990;26:998-1003.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

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