Abstract:

Objective: To investigate the effect of long tunnelled external ventricular drainage (LTEVD) for tuberculous meningitis complicated with hydrocephalus. Methods: The clinical data of 43 tuberculous meningitis patients with hydrocephalus were retrospectively collected. All of them were treated with external ventricular drainage (EVD) in the Department of Neurosurgery, The Third People’s Hospital of Shenzhen from January 2018 to May 2021. Of them, 26 were treated with traditional EVD (traditional EVD group) and 17 were treated with LTEVD (LTEVD group). The therapeutic effect and complications were compared between the two groups. Results: Seventeen patients’s drainage time was 16-67 days in the LTEVD group, with an average of (28.12±13.86) days. Among them, 5 patients (29.4%) had aggravated hydrocephalus after the removal of the long-distance external drainage tube and was treated with ventriculoperitoneal shunt surgery. The 26 patients’s single drainage time did not exceed 14 days in the traditional EVD group. Among them, 16 patients (61.5%) had recurrence of hydrocephalus after extubation and then underwent ventriculoperitoneal shunt surgery. The hospital stay of patients in LTEVD group was 30.00 (33.50, 24.00) d, which was lower than that in traditional EVD group (30.50 (39.25, 26.00) d), the difference was not statistically significant (Z=0.847, P=0.397). However, the rate of unexpected extubation, cerebrospinal fluid leakage and intracranial infection, the incidences of catheterization and secondary shunt surgery in LTEVD group were all significantly lower or less than those in traditional EVD group (0.0% (0/17) vs. 30.8% (8/26), χ²=6.426, P=0.014; 0.0% (0/17) vs. 30.8% (8/26), χ²=6.426, P=0.014; 0.0% (0/17) vs. 26.9% (7/26), χ²=5.467, P=0.031; 100.0% (17/17) vs. 180.8% (47/26), χ²=5.932, P=0.000; 29.4% (5/17) vs. 61.5% (16/26), χ²=4.246, P=0.039; respectively). Patients in both groups were followed up for 1-2 years after discharge. The total effective rate was 82.4% (14/17) in LTEVD group, and was 69.2% (18/26) in the traditional EVD group, there was no significant difference between the two groups (χ²=0.368, P=0.544). Conclusion: LTEVD is a safe and effective technology for tuberculous hydrocephalus, which with longer drainage time and fewer complications compared to the traditional EVD.

Key words: Tuberculosis, meningeal, Hydrocephalus, Ventricular drainage, Treatment outcome, Case-control studies