Rizvi Imran, Garg Ravindra Kumar, Malhotra Hardeep Singh, Kumar Neeraj, Sharma Eesha, Srivastava Chhitij, Uniyal Ravi
Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India.
Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India.
J Neurol Sci. 2017 Apr 15;375:255-263. doi: 10.1016/j.jns.2017.02.008. Epub 2017 Feb 4.
Ventriculo-peritoneal shunt surgery is one of the most commonly performed surgery for the management of tuberculous hydrocephalus. There is decreased clarity on issues regarding the indication as well as timing of cerebrospinal fluid diversion procedures in tuberculous meningitis. We systematically analysed published literature on this subject with an objective to assess the value of cerebrospinal fluid diversion procedures in tuberculous meningitis.
A systematic search of literature was performed using PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) for articles published till August 2016. All original studies, irrespective of their design, enrolling at least 10 patients with tuberculous meningitis and hydrocephalus, and in whom the outcome following ventriculo-peritoneal shunt was described, were included in this review. Data was extracted on a pre-formed data extraction sheet. Primary outcome was defined using Glasgow outcome scale (GOS).
Nineteen studies, comprising of 1038 patients, were included in the review. A majority of patients were children. Good outcome (GOS 5 and 4), following ventriculo-peritoneal shunt, was observed in 58.26% of patients; 78.57% of patients in grade I, 65.35% in grade II and 67.97% in grade III achieved a good outcome while only 31.51% in grade IV could achieve a good outcome. On subgroup analysis, 61.08% of HIV-negative patients achieved a good outcome as compared to only 25% of HIV-positive patients. There were 18.03% deaths in the HIV-negative group as compared to 66.67% deaths in the HIV-positive group after shunt surgery. The rate of complications following ventriculo-peritoneal shunt was 22.11%; shunt blockage, leading to shunt revision, was the most common complication. Majority of included studies were clinically and methodologically heterogeneous.
Outcome, following ventriculo-peritoneal shunt, depends on the clinical severity of tuberculous meningitis. HIV-infected patients have a worse prognosis when compared with HIV uninfected patients. Compared to children, corresponding data is sparse for adult patients with tuberculous meningitis.
脑室 - 腹腔分流术是治疗结核性脑积水最常用的手术之一。关于结核性脑膜炎脑脊液分流手术的适应症和时机问题，目前尚缺乏明确的认识。我们系统分析了关于该主题的已发表文献，旨在评估脑脊液分流手术在结核性脑膜炎中的价值。
使用PubMed、Scopus和Cochrane对照试验中心注册库（CENTRAL）对截至2016年8月发表的文章进行系统的文献检索。本综述纳入了所有原始研究，无论其设计如何，纳入至少10例结核性脑膜炎合并脑积水患者，并描述了脑室 - 腹腔分流术后结局的研究。数据通过预先制定的数据提取表进行提取。主要结局采用格拉斯哥结局量表（GOS）进行定义。
本综述纳入了19项研究，共1038例患者。大多数患者为儿童。脑室 - 腹腔分流术后，58.26%的患者获得了良好结局（GOS 5和4）；I级患者中78.57%获得良好结局，II级患者中65.35%获得良好结局，III级患者中67.97%获得良好结局，而IV级患者中只有31.51%获得良好结局。亚组分析显示，HIV阴性患者中有61.08%获得良好结局，而HIV阳性患者中只有25%获得良好结局。分流手术后，HIV阴性组的死亡率为18.03%，而HIV阳性组的死亡率为66.67%。脑室 - 腹腔分流术后的并发症发生率为22.11%；导致分流管修订的分流管堵塞是最常见的并发症。纳入的大多数研究在临床和方法学上具有异质性。
脑室 - 腹腔分流术后的结局取决于结核性脑膜炎的临床严重程度。与未感染HIV的患者相比，HIV感染患者的预后更差。与儿童相比，成年结核性脑膜炎患者的相应数据较少。
