{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T13:02:42Z","timestamp":1792674162527,"version":"4.5.0"},"reference-count":46,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"vor","delay-in-days":84,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian J Neurosurg"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Introduction\u2003To date, there are no standard practice guidelines available and no universal consensus regarding treatment protocol in management of tuberculous meningitis (TBM) with hydrocephalus. Over the years, diverse views have existed in neurosurgical management of TBM with hydrocephalus. Some authors advocate ventriculo-peritoneal (VP) shunt, while others suggest that external ventricular drainage (EVD) may be the preferable neurosurgical procedure for a poor-grade patient.<\/jats:p><jats:p>Method\u2003We systematically reviewed published literature and presented our institution's experience. We performed a retrospective case study in our Sarawak neurosurgical center from 2018 to 2020. We tabulated the outcome according to preoperative classifications, which were Vellore Grading (VG), Modified Vellore Grading (MVG), British Medical Research Council Classification (MRC), and others: author-defined.<\/jats:p><jats:p>Result\u2003In our center, there were 20 cases of TBM with hydrocephalus treated by EVD and VP shunt from 2018 to 2020. We systematically searched published medical literature, and 23 articles were retrieved and analyzed. Poor outcomes were observed in poor-grade patients, especially VG\/MVG 3\/4 and MRC 3, from both institution and systemic review data. Shunt complication rate was lower in our center as compared with published literature.<\/jats:p><jats:p>Conclusion\u2003Unfortunately, morbidity and mortality were approximately twofold higher in poor-grade as compared with good-grade patients. However, about one-third of poor-grade patients achieved a good outcome. Cerebrospinal fluid (CSF) diversion would be an unavoidable treatment for hydrocephalus. Poor-grade patients tend to have cerebral infarcts in addition to hydrocephalus. An extended duration of EVD placement could be a potential measure to assess Glasgow coma scale recovery and monitor serial CSF samples.<\/jats:p>","DOI":"10.1055\/s-0042-1750781","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T23:16:08Z","timestamp":1661382968000},"page":"189-198","source":"Crossref","is-referenced-by-count":6,"title":["Challenges and Controversies in the Management of Tuberculous Meningitis with Hydrocephalus: A Systematic Review and Sarawak Institution's Experience"],"prefix":"10.1055","volume":"17","author":[{"given":"Siew-Hong","family":"Yiek","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sarawak General Hospital, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert Sii-Hieng","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sarawak General Hospital, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,8,24]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1055\/s-0038-1651500","article-title":"The global neurological burden of tuberculosis","volume":"38","author":"K Thakur","year":"2018","journal-title":"Semin Neurol"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.jinf.2012.12.009","article-title":"Hydrocephalus in tuberculous meningitis: Incidence, its predictive factors and impact on the prognosis","volume":"66","author":"T Raut","year":"2013","journal-title":"J Infect"},{"issue":"27","key":"ref4","doi-asserted-by":"crossref","first-page":"iii","DOI":"10.3310\/hta7270","article-title":"Evaluating non-randomised intervention studies","volume":"7","author":"J J Deeks","year":"2003","journal-title":"Health Technol Assess"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1136\/jnnp.65.1.115","article-title":"Shunt surgery in poor grade patients with tuberculous meningitis and hydrocephalus: effects of response to external ventricular drainage and other variables on long term outcome","volume":"65","author":"J M Mathew","year":"1998","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"03","key":"ref6","first-page":"245","article-title":"Role of shunt surgery in pediatric tubercular meningitis with hydrocephalus","volume":"42","author":"D Agrawal","year":"2005","journal-title":"Indian Pediatr"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1159\/000065398","article-title":"Timing of shunt surgery in childhood tuberculous meningitis with hydrocephalus","volume":"37","author":"S Kemaloglu","year":"2002","journal-title":"Pediatr Neurosurg"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s00381-011-1572-0","article-title":"Role of ventriculoperitoneal shunt surgery in grade IV tubercular meningitis with hydrocephalus","volume":"28","author":"J Peng","year":"2012","journal-title":"Childs Nerv Syst"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1007\/s00381-014-2371-1","article-title":"A randomized study of ventriculoperitoneal shunt versus endoscopic third ventriculostomy for the management of tubercular meningitis with hydrocephalus","volume":"30","author":"P Goyal","year":"2014","journal-title":"Childs Nerv Syst"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"82","DOI":"10.21315\/mjms2021.28.5.8","article-title":"Outcome of hydrocephalus in tuberculous meningitis. 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