Comparison of ventriculoperitoneal shunt versus endoscopic third ventriculostomy in managing hydrocephalus due to tuberculous meningitis: a randomized controlled trial with a 30-day follow-up

Rupesh Raut; Shahzad Shams; Gianluca Scalia; Giuseppe Emmanuele Umana; Sruthi Ranganathan; Muddassar Rasheed; Atul Vats; Bipin Chaurasia

doi:10.1097/MS9.0000000000001701

Comparison of ventriculoperitoneal shunt versus endoscopic third ventriculostomy in managing hydrocephalus due to tuberculous meningitis: a randomized controlled trial with a 30-day follow-up

Ann Med Surg (Lond). 2024 Jan 10;86(2):881-885. doi: 10.1097/MS9.0000000000001701. eCollection 2024 Feb.

Authors

Rupesh Raut¹, Shahzad Shams², Gianluca Scalia³, Giuseppe Emmanuele Umana⁴, Sruthi Ranganathan⁵, Muddassar Rasheed², Atul Vats⁶, Bipin Chaurasia⁷

Affiliations

¹ Department of Neurosurgery, Patan Hospital, Patan Academy of Health Sciences, Lalitpur.
² Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan.
³ Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital.
⁴ Department of Neurosurgery, Gamma Knife and Trauma Center, Cannizzaro Hospital, Catania, Italy.
⁵ School of Medicine, Cambridge University, Cambridge.
⁶ James Cook University Hospital, Middlesbrough, UK.
⁷ Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal.

Abstract

Background: Hydrocephalus is a significant complication arising from tuberculous meningitis (TBM). While ventriculoperitoneal shunt (VPS) remains the primary surgical approach for TBM-related hydrocephalus, there is a rising trend in the use of endoscopic third ventriculostomy (ETV).

Materials and methods: This randomized controlled trial, conducted from February 2018 to July 2019, enroled 60 patients aged 20-50 with TBM-related hydrocephalus. Patients underwent either VPS or ETV. Both groups were followed up for a minimum of 30 days, evaluating clinical outcomes and modifications in the modified Vellore grading system. Glasgow Coma Scale (GCS) assessments were conducted at 7-days and 30-day post-surgery for both groups.

Results: The mean GCS scores were comparable between the two groups on the 7th and 30th postoperative days. The association between modified Vellore Grade and treatment modality did not show statistically significant differences (P=1.0 and P=0.3) on the seventh and thirtieth postoperative days respectively.

Conclusions: Both VPS and ETV demonstrate efficacy in managing hydrocephalus secondary to TBM in adult patients. Our 30-day outcomes did not reveal discernible differences between the two procedures. Therefore, considering technical expertise and experience with ETV, it may be considered as the primary choice for cerebrospinal fluid (CSF) diversion in TBM-associated hydrocephalus, owing to its avoidance of several lifelong complications linked with VPS.

Keywords: CSF Diversion; Glasgow Coma Scale; Ventriculoperitoneal Shunt; endoscopic third ventriculostomy; hydrocephalus; modified vellore grading; surgical intervention; tuberculous meningitis.