Intracranial tuberculoma: diagnosis treatment and outcome

ABSTRACT

Intracranial tuberculomas are conglomerate caseous foci within the substance of the brain that develop from deep-seated tubercles acquired during recent or remote hematogenous dissemination. In this study twenty four patients 10 male and 14 female with intracranial tuberculomas were treated and followed up in the neurosurgery and neurology departments in Al-Azhar University Hospitals and Nasr City Health Insurance Hospital in the period between January 1994 and July 2000. The age of the patients ranged between 6 and 48 year with a mean age of 30.1 year. The data were analyzed for presenting symptoms, its duration, physical findings, investigations and treatment. Half of the patients had past history of pulmonary tuberculosis. Fourteen patients had surgical excision. Four patients had stereotactic biopsy. Six patients had medical antituberculous treatment without excision or biopsy but one of these patients had ventriculo-peritoneal, shunt to treat the associated hydrocephalus all the patients were followed up every 6 months for a period ranged between 6-30 months with a mean period of 23.5 months. Thirteen out of the 24 patients showed improvement of their disability score on the 1st follow up after 6 months while the other 11 has the same disability score. Five out of these 11 patients showed improvement on the next follow up after 12 months while the other 6 had the same disability level. Three out of the non improved cases did not show improvement of their disability level till the end of the study, while the other 3 had improved disability level after 18 months for the 1st 2 cases and after 24 months for the 3rd patient. Ten out of the 14 patients who had craniotomy or craniectomy and tuberculoma excisions reached to disability level 0 while 2 had partial improvement and the last 2 had the same disability level as before management. Four of our patients had stereotactic biopsy and medical treatment. Three out of them reached to disability level 0 on follow up while 1 patient had partial improvement. patients who had only medical treatment were 6. Three out of them reached to disability level 0 on follow up while 2 patients had partial improvement and the 6th case had the same disability level as before management. The clinical picture of intracranial tuberculoma simulates an intracranial neoplasm, so it becomes necessary for physicians in countries where tuberculosis is common to search for any concomitant evidence of tuberculosis in every case of suspected intracranial tumor. Intracranial tuberculoma could be treated medically unless we are not sure of the diagnosis or if the tuberculoma is associated with mass effect which threatens the life of the patient