DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20185398

ETV in tuberculous meningitis with hydrocephalus and allergic reaction to VP shunt: a case report

Rohadi M. Rosyidi, Bambang Priyanto, Muhammad Arifin Parenrengi

Abstract


Hydrocephalus is one of the most common complications of tuberculous meningitis (TBM) occurring in up to 85% of patients with the disease. The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus in tuberculous meningitis (TBM). Although allergic reactions to the silicone in shunt device are very rare, the authors describe a case of silicone allergy causing multiple VP shunt revisions. Alternative choice is endoscopic third ventriculostomy (ETV), but it is debatable. ETV has variable success in these patients and is generally not advisable in patients in the acute stages of the disease. A 19-year-old woman with hydrocephalus in tuberculous meningitis, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissue surrounding the shunt tubing. Laboratory examination demonstrated high level IgE, high level ESR, and PCR-TBC Positive, related to the allergic reaction. Patient with ETV success score of 50. Patients received ETV and release VSS Shunt. ETV has success in these patients. VP Shunts complications remain a difficult problem in neurosurgical clinical practice. The most typical complications are mechanical obstruction and infection. Allergy to the silicone shunt tubing is quite rare. Silicone allergy is an even more rare occurrence because of its high biocompatibility and low biological reactivity. It is a challenge for ETV when TBM has difficulty to recognize anatomical landmarks on this patient. It could also consider in patients who have shunt failure, and might be a better option than shunt revision.


Keywords


Allergic reactions, ETV, hydrocephalus, Tuberculous meningitis, VP Shunt

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References


Rajshekhar V. Management of hydrocephalus in patients with tuberculous meningitis. Neurology India. 2009 Jul 1;57(4):368.

Patir R, Bhatia R. Management of tuberculous infections of the nervous system. In: Schmidek and Sweet Operative neurosurgical Techniques: Indications, Method, and Results. 6th ed. 2012:1679-1690.

Dastur DK, Manghani DK, Udani PM. Pathology and pathogenetic mechanisms in neurotuberculosis. Radiol Clin North Am. 1995;33:733-52.

Palur R, Rajshekhar V, Chandy MJ, Joseph T, Abraham J. Shunt surgery for hydrocephalous in tubercular meningitis: A long-term follow-up study. J Neurosurg. 1991;74:64-9.

Chakraborty A, Drake JM, Warf BC. Methods for cerebrospinal fluid diversion in pediatric hydrocephalus: from shunt to scope. In: Schmidek and Sweet Operative neurosurgical Techniques: Indications, Method, and Results. 6th ed. 2012:631-653.

Hussain NS, Wang PP, James C, Carson BS, Avellino AM. Distal ventriculoperitoneal shunt failure caused by silicone allergy: Case report. J Neurosurg. 2005 Mar;102(3):536-9.

Kulkarni AV, Riva-Cambrin J, Browd SR. Use of the ETV Success Score to explain the variation in reported endoscopic third ventriculostomy success rates among published case series of childhood hydrocephalus. J Neurosurg: Pedia. 2011 Feb;7(2):143-6.

Kulkarni AV, Drake JM, Kestle JR, Mallucci CL, Sgouros S, Constantini S. Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score. J Neurosurg: Pedia. 2010 Oct;6(4):310-5.

Jallo GI, Kothbauer KF, Abbott IR. Endoscopic third ventriculostomy. Neurosurg Focus. 2005 Dec;19(6):1-4.

Bouras T, Sgouros S. Complications of endoscopic third ventriculostomy: a review. J Neurosurg: Pedia. 2011 Jun;7(6):643-9.