Jadhav R N, Palande D A
Department of Neurosurgery, Grant Medical College and Sir J.J. Group of Hospitals, Byculla, Mumbai, India.
Neurosurgery. 1999 Dec;45(6):1345-9; discussion 1349-50. doi: 10.1097/00006123-199912000-00016.
Tuberculosis is endemic in developing countries. However, calvarial tuberculosis is rare and only a few cases have been reported. In a review of the literature, we found only six cases of calvarial tuberculosis reported with computed tomographic findings. We report a series of seven patients with calvarial tuberculosis, and we discuss their presentations and treatments.
The patients were studied with respect to age and sex prevalences, previous histories of trauma and tuberculosis, and presenting complaints. Plain cranial x-ray films and computed tomographic scans were used for diagnoses. All patients underwent surgery and antituberculous chemotherapy.
Of the presenting patients, 71.42% were less than 20 years of age. There was a female predominance, with a male/female ratio of 1:6. Painless swelling and discharging sinuses over the scalp were the most common presenting features. One patient presented with osteomyelitis and sinus formation, with associated meningitis. All patients recovered well after surgery and antituberculous chemotherapy, except for one patient who discontinued drug treatment.
Although calvarial tuberculosis is rare, the possibility of this disease should be considered when patients report previous histories of tuberculosis or are from areas in which the disease is endemic. Surgery is indicated in cases with associated neurological deficits or sinus formation. Antituberculous therapy should be continued for 18 months.
结核病在发展中国家呈地方性流行。然而，颅骨结核较为罕见，仅有少数病例被报道。在文献回顾中，我们仅发现6例有计算机断层扫描结果报道的颅骨结核病例。我们报告了一组7例颅骨结核患者，并讨论了他们的临床表现和治疗方法。
对患者的年龄和性别分布、既往创伤和结核病史以及就诊主诉进行了研究。采用头颅平片和计算机断层扫描进行诊断。所有患者均接受了手术及抗结核化疗。
在就诊患者中，71.42%年龄小于20岁。女性占优势，男女比例为1:6。头皮无痛性肿胀和排脓窦是最常见的临床表现。1例患者表现为骨髓炎和窦道形成，并伴有脑膜炎。除1例患者中断药物治疗外，所有患者经手术及抗结核化疗后恢复良好。
尽管颅骨结核罕见，但当患者有结核病史或来自该病地方性流行地区时，应考虑该病的可能性。对于伴有神经功能缺损或窦道形成的病例，应进行手术治疗。抗结核治疗应持续18个月。
