Clinical Pattern and Post-Operative Complications of Post Tuberculous Meningitis Hydrocephalus in Patients Underwent Ventriculoperitoneal Shunt

Objective: To determine the clinical presentation of post tuberculous meningitis hydrocephalus and post-operative complications in patients underwent placement of a ventriculoperitoneal shunt.Study Design: This Quasi-experimental study was conducted at Department of Neurosurgery of Dow University of Health Sciences/ Civil Hospital, Karachi. Study duration was six months from October 2013 to March 2014.Methodology: Total 40 patients were studied who were diagnosed as cases of tuberculous meningitis and hydrocephalus on the basis of history, clinical examination, CSF findings, CT and MRI. Each patient underwent placement of a ventriculoperitoneal shunt. All the data regarding clinical presentation and postoperative complications was recorded in the proformaRESULTS: Total 40 patients having tuberculous meningitis hydrocephalus were selected; their mean age was 16.4+07.8 years. Male were found in the majority 62.50%, as compared to female 37.50%. According to the clinical presentation, most patients 70.0% were presented with a headache and 62.50% with fever, followed by nausea and vomiting was in 37.5% patients, Neck rigidity was in 27.50% cases, extra neural tuberculosis in 25.0% patients, papilledema in 22.50% cases, limb weakness in 10.0% patients, while fits were found only in 5.0% of the patients. Past history of tuberculosis was in 7.50% patients. According to postoperative complications infection was found in 10.0% of the cases, peritoneal pseudo-cyst without infection was in 7.5% cases, while 10.0% patients died. No significant difference was found in the postoperative complications according to gender p-value 0.94.Conclusion: It is concluded that a headache, fever and nausea/vomiting were the commonest clinical features and the Ventriculoperitoneal shunt is relatively simple and suitable for the patients of all age groups with hydrocephalus, its complications are relatively easy to manage

Neuroendoscopic Management of Hydrocephalus in Children

Objective: To determine the Neuroendoscopic management of hydrocephalus in children.Materials and Methods: The study was conducted at the Department of Neurosurgery, Peoples University of Medical and Health Science for women Nawabshah from January 2014 to May 2015. All of the patients with hydrocephalus diagnosed on history, clinical examination and CT scan included in the study. Subjects with co–morbidities such as uncontrolled diabetes, cardiac diseases or uremia were excluded. Patients with age of 6 months to 13 years either gender were included in the study. Aesculap rigid rod lens neuroendoscope with 0 degree was utilized. Warm ringers were utilized for irrigation, a Fogarty embolectomy catheter was utilized for ETV. Hemostasis was accomplished with irrigation, tamponade or coagulation. Endoscopic third ventriculostomy (ETV) was labeled successfully when characteristics of intracranial hypertension (ICP) clinically improved and the size of ventricular decreased on post-operative CT scan. All the data was recorded in the Proforma.Results: Thirty patients with male to female ration 2.5:1 were administered. Age ranged between 6 months and 12 years with a mean of 22.03 months. There were 15(%) cases of Tri Ventricular Hydrocephalus, 10 cases of Tetra Ventricular Hydrocephalus. Two cases of Dandy Walker Hydrocephalus, one case of Asymmetrical Ventricles Hydrocephalus and postoperative fever occurred in two subjects. CSF leak appeared in one patient who was managed conservatively. No operative mortality was found.ETV worked effectively for Hydrocephalus treatment in 99.9% patients included in the study