Does CSF composition predict shunt malfunction in Tuberculous Meningitis.

ABSTRACT

Background: Hydrocephalus secondary to tuberculous meningitis (TBM) continues to be a challenging condition to treat for neurosurgeons in developing countries. Shunt complications are reportedly more frequent in patients undergoing ventriculo-peritoneal shunt in patients with TBM than in those undergoing shunt surgeries for other causes. Aim: The aim of this study was to evaluate the relationship of cerebrospinal fluid (CSF) composition on shunt malfunction. Methods: We compared the CSF composition of 53 patients who had shunt malfunction during a five year period with that of 137 matched controls. Results: Patients who had shunt malfunction had a significantly higher concentration of CSF protein. The CSF cellularity and glucose concentration did not have any significant bearing in predicting shunt malfunction. Patients with CSF protein concentration of more than 200 mg/dL had a four times higher risk of having shunt malfunction than those with a concentration of less than 100 mg/dL. Patients with CSF protein in the 100-200 mg/dL range represent an intermediate zone. Conclusion: To conclude, patients with CSF protein concentration of more than 200 mg/dL have a significantly higher risk of shunt malfunction and hence have to be followed up closely.