Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
BMC Infect Dis. 2023 Oct 30;23(1):742. doi: 10.1186/s12879-023-08661-7.
Hydrocephalus is a frequent complication of tuberculous meningitis (TBM), and ventriculoperitoneal shunt (VPS) has been shown to improve short-term prognosis for patients with TBM-associated hydrocephalus. However, questions remain about long-term prognosis and shunt-related complications. This study aims to provide a comprehensive assessment of both long-term prognosis and shunt-related complications in patients with TBM-induced hydrocephalus who have undergone VPS treatment.
This retrospective study analyzed the clinical data of TBM patients with hydrocephalus treated with VPS at Peking Union Medical College Hospital between December 1999 and February 2023. Both short-term outcomes at discharge and long-term outcomes during follow-up were examined. Prognosis and shunt-related complications were assessed using the modified Rankin Scale (mRS) and the Activity of Daily Living (ADL) score to evaluate neurological function and autonomic living ability, respectively.
A total of 14 patients with TBM-associated hydrocephalus were included in this study. Of these, 92.9% (13/14) exhibited favorable short-term outcomes, while 57.1% (8/14) showed positive long-term outcomes. Initial results indicated 6 complete recoveries (CR), 7 partial recoveries (PR), and 1 treatment failure. No catheter-related complications were observed initially. Long-term results included 4 CRs, 4 PRs, and 6 treatment failures. A variety of shunt surgery-related complications were noted, including three instances of catheter obstruction, one of incision infection, one of catheter-related infection, one of acute cerebral infarction, and one of transient peritoneal irritation accompanied by diarrhea.
VPS appears to be an effective and well-tolerated treatment for TBM-associated hydrocephalus, efficiently alleviating acute intracranial hypertension. Nonetheless, continuous long-term monitoring and proactive management are essential to mitigate the risk of catheter-related complications.
脑积水是结核性脑膜炎（TBM）的常见并发症，脑室-腹腔分流术（VPS）已被证明可改善 TBM 相关脑积水患者的短期预后。然而，对于 VPS 治疗 TBM 相关脑积水患者的长期预后和分流相关并发症仍存在疑问。本研究旨在全面评估 VPS 治疗 TBM 相关脑积水患者的长期预后和分流相关并发症。
本回顾性研究分析了 1999 年 12 月至 2023 年 2 月期间在北京协和医院接受 VPS 治疗的 TBM 伴脑积水患者的临床资料。出院时的短期结局和随访期间的长期结局均进行了检查。使用改良 Rankin 量表（mRS）和日常生活活动（ADL）评分评估预后和分流相关并发症，分别评估神经功能和自主生活能力。
本研究共纳入 14 例 TBM 相关脑积水患者。其中，92.9%（13/14）患者出院时短期结局良好，57.1%（8/14）患者长期结局良好。初步结果显示完全恢复（CR）6 例，部分恢复（PR）7 例，治疗失败 1 例。初始时无导管相关并发症。长期结果包括 4 例 CR、4 例 PR 和 6 例治疗失败。出现各种分流手术相关并发症，包括导管阻塞 3 例、切口感染 1 例、导管相关感染 1 例、急性脑梗死 1 例和短暂性腹膜刺激伴腹泻 1 例。
VPS 似乎是治疗 TBM 相关脑积水的一种有效且耐受良好的治疗方法，可有效缓解急性颅内高压。然而，需要进行持续的长期监测和积极的管理，以降低导管相关并发症的风险。
