Neurosurgical methods in the treatment of tuberculous meningitis with a note on some unusual manifestations of the disease

Abstract

Frontal burr-holes for tapping the lateral ventricles have proved to be necessary in about one-third of our cases of tuberculous meningitis treated with streptomycin. Apart from this minor operation, neurosurgical procedures are not called for in most cases. However, there is the occasional case (three in our first 125) in which a major operation to deal with some unusual cause of raised intracranial pressure is essential to save life. In retrospect, when we can see the whole course of the cerebrospinal fluid reaction and the results of bacteriological cultures, and can correlate these with the clinical events, it is not difficult to perceive that these cases are unusual. But at the time they can closely resemble the usual type of tuberculous meningitis, and it is all too easy to overlook the urgent need for special neurosurgical investigations and treatment. It is clearly of the greatest importance that during streptomycin treatment each case should be frequently re-assessed by thorough neurological examination and study of the cerebrospinal fluid charts; and that ventriculography or cerebral angiography should be undertaken if the headaches are unusually severe, if there are signs-of disturbed function of a cerebral hemisphere, or if the case is taking an unusual course under treatment.