Kemaloglu Serdar, Ozkan Umit, Bukte Yaşar, Ceviz Adnan, Ozates Mustafa
Department of Neurosurgery, School of Medicine, Dicle University, Diyarbakir, Turkey.
Pediatr Neurosurg. 2002 Oct;37(4):194-8. doi: 10.1159/000065398.
Hydrocephalus is a common complication of tuberculous meningitis (TBM) in children. The aims of this study are to review our experience of hydrocephalus in childhood TBM and to evaluate the effect of the timing of ventriculoperitoneal shunting (VPS) on the final outcome. In this study, 156 patients with TBM and hydrocephalus were reviewed retrospectively between 1990 and 2000. Patients' ages ranged from 6 months to 15 years, with a mean age of 4.1 years. There were 85 boys, and the male-to-female ratio was 1.19:1.0. Sixty-two percent of the children were younger than 6 years old. VPS was performed 2 days after the diagnosis in 100 patients, and in the remaining 56 patients, 3 weeks after the diagnosis. The average follow-up period was 8.5 months. Good recovery or minor sequelae was seen in 82 patients (52.6%), and 51 died (12.3%). The timing of the VPS procedure and cerebral complications had an effect on the final outcome. Early VPS gave a better outcome in mild and moderate hydrocephalus (p = 0.040). This study has shown that early surgical procedure for mild/moderate hydrocephalus has a positive effect on the morbidity and mortality of hydrocephalus in childhood TBM (p = 0.014, p = 0.040, respectively). In severe hydrocephalus, there was a tendency for early shunting to have a positive effect on morbidity, although this did not reach statistical significance.
脑积水是儿童结核性脑膜炎（TBM）的常见并发症。本研究的目的是回顾我们在儿童TBM并发脑积水方面的经验，并评估脑室腹腔分流术（VPS）时机对最终结局的影响。本研究回顾性分析了1990年至2000年间156例TBM并发脑积水的患者。患者年龄从6个月至15岁不等，平均年龄为4.1岁。其中男孩85例，男女比例为1.19:1.0。62%的儿童年龄小于6岁。100例患者在诊断后2天进行了VPS，其余56例患者在诊断后3周进行了VPS。平均随访期为8.5个月。82例患者（52.6%）恢复良好或有轻微后遗症，51例死亡（12.3%）。VPS手术时机和脑部并发症对最终结局有影响。早期VPS在轻度和中度脑积水中效果更好（p = 0.040）。本研究表明，早期对轻度/中度脑积水进行手术对儿童TBM并发脑积水的发病率和死亡率有积极影响（分别为p = 0.014，p = 0.040）。在重度脑积水中，早期分流对发病率有积极影响的趋势，尽管未达到统计学意义。
