Management of cerebral tuberculoma

ABSTRACT

Cerebral tuberculosis in developing countries is still a common disease, and there is an emergence of cerebral tuberculoma. Involvement of the brain by tuberculoma is a serious complication of cerebral tuberculosis and in rare cases an abscess or multiple tubercular abscesses may result. The management is controversial among the neurosurgical services which could be excision or stereotactic aspiration, or by conservative treatment with anti-tuberculous chemotherapy alone. Twenty-four patients with either histological confirmation of tuberculoma or classical radiological image appearance of the tuberculoma with complete structural disappearance of tuberculous lesion due to anti-tuberculous chemotherapy were reviewed retrospectively in the Neurosurgery Department, King Fahd Hospital of the University from June 1982 - June 1999. We tend to favour a surgical approach in cases with cystic lesion with marked cerebral compression or midline cerebral displacement either by stereotactic aspiration or excision alone. In addition, we also recommend conservative treatment when there is no evidence of clinical and/or radio-logical deterioration. The protocol for management of cerebral tuber-culoma is also discussed