Clinical Analysis of Surgical Treatment of Postmeningitic Hydrocephalus

ABSTRACT

To evaluate the surgical results, the author made a clinical analysis on 70 patients of postmeningitic hydrocephalus who had been treated surgically. And the results were summarized as follows. 1) The tuberculous meningitis was the most common type causing the postmeningitic hydrocephalus(72.9%). 2) Among 70 patients, 51 were male and 19 were female. About 40% of cases were under 5 years old. 3) The most common clinical symptom was vomiting(67%). Headache, fever and generalized seizure were symptoms in order of frequency. Neurological sings represented neck stiffness, cranial nerve palsy and motor weakness. 4) The most common clinical condition on admission was stage 3 (advanced cases with unconciousness and severe neurological deficits). 5) The spinal fluid analysis showed more abnormal findings comparing to the ventricular fluid. But ventricular pressure was higher than spinal fluid pressure. 6) Plain skull x-rays, carotid angiograms were useful diagnostic methods but CT brain scan was though to be the most accurate, noninvasive method which showed size of ventricle and effectiveness of shunting procedures with Evans'ratio. In enhanced CT brain scans, the basal cistern enhancement was the most common finding beside ventricular enlargement (64.1%). 7) Ventriculoperitoneal shunting was the most common procedure in this series. 8) The initial revision rate was 12/70(19%) and the most of the revision was performed within 6 months after the initial shunting. 9) The revision rate in relation to shunting system and cerebrospinal fluid finding was not statistically significant. 10) The most common cause of the shunt malfuntion was obstruction of the ventricular catheter. 11) Forty one patients(58.6%) showed favorable outcome. The motality rate was 14/70(20%) and they were all belong to the stage 3. About half of the patients in stage 2 and stage 3 showed dramatic improvement after early shunting procedures. So the timing of operation was the most important factor influencing their outcome.