Seow W T, Yeo T T, Ong P L
Dept of Neurosurgery, Tan Tock Seng Hospital, Singapore.
Singapore Med J. 1991 Dec;32(6):427-30.
Tuberculomas of the brain are relatively uncommon in developed countries nowadays. We report the only two cases that were seen in our Department in the last five years. Both patients presented with seizures and were found to have space occupying lesions on cranial CT scanning. They had no past history of tuberculosis, no evidence of current extracranial tuberculosis and the diagnosis of tuberculoma was made at the time of surgical excision. Underdiagnosis of tuberculoma of the brain is likely to occur in industrialised countries where tuberculosis is rare. The radiological investigation of choice is CT scanning with contrast enhancement and the presence of a target lesion is considered to be pathognomonic of a tuberculoma. Most tuberculomas of the brain can be treated medically with antituberculous chemotherapy. We recommended obtaining a definitive histological diagnosis with CT-guided stereotactic techniques prior to commencing antituberculous therapy. Surgical excision is necessary in patients with raised intracranial pressure secondary to the lesion and not responding to medical therapy.
如今，脑结核瘤在发达国家相对并不常见。我们报告了过去五年里在我们科室见到的仅有的两例病例。两名患者均表现为癫痫发作，头颅CT扫描发现有占位性病变。他们既往无结核病史，目前无颅外结核的证据，脑结核瘤的诊断是在手术切除时做出的。在结核病罕见的工业化国家，脑结核瘤很可能会被漏诊。首选的影像学检查是增强CT扫描，靶病变的存在被认为是结核瘤的特征性表现。大多数脑结核瘤可以通过抗结核化疗进行药物治疗。我们建议在开始抗结核治疗之前，采用CT引导下的立体定向技术获得明确的组织学诊断。对于因病变导致颅内压升高且药物治疗无效的患者，手术切除是必要的。
