Can CT predict the level of CSF block in tuberculous hydrocephalus?

Introduction: Treatment of obstructive hydrocephalus in children with tuberculous meningitis (TBM) depends on the level of the cerebrospinal fluid (CSF) block. Air-encephalography is regarded as the gold standard for differentiating communicating and non-communicating hydrocephalus. Since air-encephalography involves a lumbar puncture, it carries the risk of cerebral herniation. Aim: The aim of this study was to determine whether communicating and non-communicating hydrocephalus in TBM can be differentiated by means of cranial computerised tomography (CT). Methods: A number of CT indices were measured in 50 children with communicating and 34 children with non-communicating hydrocephalus according to air-encephalographic findings. Results: The only CT finding that correlated with the type of hydrocephalus was the shape of the third ventricle. Significantly more children with non-communicating hydrocephalus had a rounded third ventricle than those with communicating hydrocephalus. Conclusion: CT is therefore not useful in determining the level of CSF block in TBM. Air-encephalography remains the most reliable way of determining the level of CSF obstruction. © Springer-Verlag 2004.Articl