Chen Fanfan, Chen Lei, Cao Yongfu, Yi Yongjun, Zhuang Jingwen, Le Wuhua, Xie Wei, Tu Lanbo, Li Peng, Fang Yimin, Li Ling, Kou Yuqing, Fu Kaikai, He Hua, Ju Hongbin
Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, 1# Panfu Road, Guangzhou, Guangdong, 510180, China.
Neurosurgery Department, Shenzhen Second People's Hospital, Shenzhen University, 3002# Sungang Road, Shenzhen, 518037, China.
BMC Neurol. 2018 Jan 18;18(1):10. doi: 10.1186/s12883-017-0996-x.
Central nervous system (CNS) tuberculoma is a rare disease with severe neurological deficits. This retrospective research is to review the data of patients diagnosed as CNS tuberculoma. Surgeries were performed in all patients. The clinical features especially the neurological image and the anatomical characters of the tuberculomas were concerned.
Totally 11 patients diagnosed as CNS tuberculoma were admitted in Guangzhou First People's Hospital (7cases) and Changzheng Hospital (4 cases) during 2006-2015. The data including preoperative condition, neurological imaging, and surgical findings was collected and analyzed.
The lesions of nine patients (9/11) were totally or subtotally excised and two (2/11) were partially excised. Neurological functions of all patients were improved after surgery without secondary infection. Lesions of nine (9/11) patients preoperatively progressed as a result of paradoxical reaction. Of the 9 patients demonstrated paradoxical progression, all lesions were partially or totally located at the cisterns or the subarachnoid space. Preoperative ATTs lasted 2 to 12 months and tuberculomas were not eliminated. The arachnoid was found thickened and tightly adhered to the lesions during surgeries. Of the 2 cases that paradoxical reaction were excluded, both patients (case 6, intramedullary tuberculoma; case 11, intradural extramedullary tuberculoma) were admitted at onset of the disease. ATTs were preoperatively given for 1 week as neurological deficits aggravated. The tuberculous lesions of CNS or other system showed no obvious change and paradoxical reaction could not be established in both cases.
Exudates of tuberculosis is usually accumulated in the cisterns and frequently results in the paradoxical formation of tuberculoma. Intracisternal tuberculoma is closely related to paradoxical reaction and refractory to anti-tuberculosis therapy. Micro-surgical excision is safe and effective. Early surgical intervention may be considered in the diagnosis of intracisternal tuberculoma especially when paradoxical reaction participates in the development of tuberculoma.
中枢神经系统（CNS）结核瘤是一种罕见疾病，伴有严重神经功能缺损。本回顾性研究旨在回顾诊断为CNS结核瘤患者的数据。所有患者均接受了手术治疗。关注临床特征，尤其是神经影像学表现以及结核瘤的解剖学特征。
2006年至2015年期间，广州医科大学附属第一医院（7例）和长征医院（4例）共收治11例诊断为CNS结核瘤的患者。收集并分析包括术前情况、神经影像学及手术结果等数据。
9例患者（9/11）的病灶被完全或次全切除，2例（2/11）为部分切除。所有患者术后神经功能均有改善，无继发感染。9例（9/11）患者的病灶术前因反常反应而进展。在出现反常进展的9例患者中，所有病灶均部分或全部位于脑池或蛛网膜下腔。术前抗结核治疗持续2至12个月，结核瘤未消除。手术中发现蛛网膜增厚并与病灶紧密粘连。在排除反常反应的2例患者中，2例患者（病例6，髓内结核瘤；病例11，硬脊膜下髓外结核瘤）均在疾病发作时入院。术前抗结核治疗1周后神经功能缺损加重。中枢神经系统或其他系统的结核病灶无明显变化，2例均未出现反常反应。
结核性渗出物通常积聚在脑池中，常导致结核瘤的反常形成。脑池内结核瘤与反常反应密切相关，抗结核治疗效果不佳。显微手术切除安全有效。对于脑池内结核瘤的诊断，尤其是当反常反应参与结核瘤的发展时，可考虑早期手术干预。
