{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T01:23:52Z","timestamp":1772069032672,"version":"3.50.1"},"reference-count":31,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T00:00:00Z","timestamp":1663113600000},"content-version":"vor","delay-in-days":1383,"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":[[2018,12]]},"abstract":"<jats:p>Objectives: The objective of this study was to compare safety and efficacy of endoscopic third ventriculostomy (ETV) versus ventriculoperitoneal (VP) shunt in the treatment of hydrocephalus in tuberculous meningitis (TBM) and to assess clinical and radiological profiles of patients with TBM that would be better suited to either VP shunt or ETV. Methods: This study was a single-center randomized prospective study on 52 patients with TBM hydrocephalus in the pediatric age group (&lt;18 years of age). Patients included in the study were randomized into undergo either VP shunt or ETV. Both groups were followed up for a minimum of 5 months and assessed for success and failure rates as well as procedural complications and neurologic sequelae. Results: Twenty-six patients underwent ETV with a success rate of 65.4% with six of nine failures occurring within the first 16 days after surgery (median time to failure \u2013 3 days). In the VP shunt group, there was a success rate of 61.54% and a median time to failure of 50 days. Modified Vellore grading was found to be a significant factor in determining outcome in both ETV and VP shunt groups with high-grade TBM consistently associated with poor outcome (odds ratio = 4.2). Conclusions: ETV can be performed effectively in young children including infants, as well as those with communicating hydrocephalus, high cerebrospinal fluid (CSF) cell counts, and protein levels with a lower rate of failure than that of VP shunt. Hence, ETV should be attempted as the first-choice CSF diversion procedure in hydrocephalus secondary to TBM where technical expertise and experience with this procedure is available as it avoids the myriad of lifelong complications associated with shunts.<\/jats:p>","DOI":"10.4103\/ajns.ajns_107_18","type":"journal-article","created":{"date-parts":[[2018,10,23]],"date-time":"2018-10-23T13:08:00Z","timestamp":1540300080000},"page":"1140-1147","source":"Crossref","is-referenced-by-count":28,"title":["A randomized study comparing endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the management of hydrocephalus due to tuberculous meningitis"],"prefix":"10.1055","volume":"13","author":[{"given":"Andrew","family":"Aranha","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Bhaskar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,9,14]]},"reference":[{"key":"key-10.4103\/1793-5482.243725-1","first-page":"368","volume-title":"Management of hydrocephalus in patients with tuberculous meningitis","author":"Rajshekhar","year":"2009","journal-title":"Neurol India","ISSN":"https:\/\/id.crossref.org\/issn\/0028-3886","issn-type":"print"},{"key":"key-10.4103\/1793-5482.243725-2","first-page":"194","volume-title":"Timing of shunt surgery in childhood tuberculous meningitis with hydrocephalus","author":"Kemaloglu","year":"2002","journal-title":"Pediatr Neurosurg"},{"key":"key-10.4103\/1793-5482.243725-3","first-page":"1029","volume-title":"Shunting in tuberculous meningitis: A neurosurgeon's nightmare","author":"Sil","year":"2008","journal-title":"Childs Nerv Syst"},{"key":"key-10.4103\/1793-5482.243725-4","first-page":"803","volume-title":"Tuberculous meningitis: A uniform case definition for use in clinical research","author":"Marais","year":"2010","journal-title":"Lancet Infect Dis"},{"key":"key-10.4103\/1793-5482.243725-5","first-page":"301","volume-title":"Updated national guidelines for pediatric tuberculosis in India, 2012","author":"Kumar","year":"2013","journal-title":"Indian Pediatr"},{"key":"key-10.4103\/1793-5482.243725-6","first-page":"e147","volume-title":"Official American Thoracic Society\/Centers for Disease Control and Prevention\/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of drug-susceptible tuberculosis","author":"Nahid","year":"2016","journal-title":"Clin Infect Dis"},{"key":"key-10.4103\/1793-5482.243725-7","first-page":"536","volume-title":"Joint tuberculosis committee of the British Thoracic Society","author":"Chemotherapy","year":"1998","journal-title":"Thorax"},{"key":"key-10.4103\/1793-5482.243725-8","first-page":"1741","volume-title":"Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults","author":"Thwaites","year":"2004","journal-title":"N Engl J Med"},{"key":"key-10.4103\/1793-5482.243725-9","first-page":"1699","volume-title":"Management of post-tubercular hydrocephalus","author":"Tandon","year":"2011","journal-title":"Childs Nerv Syst"},{"key":"key-10.4103\/1793-5482.243725-10","first-page":"64","volume-title":"Shunt surgery for hydrocephalus in tuberculous meningitis: A long-term follow-up study","author":"Palur","year":"1991","journal-title":"J Neurosurg"},{"key":"key-10.4103\/1793-5482.243725-11","first-page":"229","volume-title":"Rapid detection of Mycobacterium tuberculosis and rifampin resistance by use of on-demand, near-patient technology","author":"Helb","year":"2010","journal-title":"J Clin Microbiol"},{"key":"key-10.4103\/1793-5482.243725-12","first-page":"137","volume-title":"Complex hydrocephalus (combination of communicating and obstructive type): An important cause of failed endoscopic third ventriculostomy","author":"Yadav","year":"2009","journal-title":"BMC Res Notes"},{"key":"key-10.4103\/1793-5482.243725-13","first-page":"155","volume-title":"Water jet dissection technique for endoscopic third ventriculostomy minimises the risk of bleeding and neurological complications in obstructive hydrocephalus with a thick and opaque third ventricle floor","author":"Yadav","year":"2010","journal-title":"Minim Invasive Neurosurg"},{"key":"key-10.4103\/1793-5482.243725-14","first-page":"161","volume-title":"Endoscopic third ventriculostomy in infants","author":"Yadav","year":"2006","journal-title":"Neurol India","ISSN":"https:\/\/id.crossref.org\/issn\/0028-3886","issn-type":"print"},{"key":"key-10.4103\/1793-5482.243725-15","first-page":"855","volume-title":"Endoscopic third ventriculostomy in tubercular meningitis with hydrocephalus","author":"Yadav","year":"2011","journal-title":"Neurol India","ISSN":"https:\/\/id.crossref.org\/issn\/0028-3886","issn-type":"print"},{"key":"key-10.4103\/1793-5482.243725-16","first-page":"325","volume-title":"Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus","author":"Yadav","year":"2016","journal-title":"Asian J Neurosurg","ISSN":"https:\/\/id.crossref.org\/issn\/1793-5482","issn-type":"print"},{"key":"key-10.4103\/1793-5482.243725-17","first-page":"35","volume-title":"Factors affecting the outcome of neuroendoscopy in patients with tuberculous meningitis hydrocephalus: A preliminary study","author":"Jha","year":"2007","journal-title":"Surg Neurol"},{"key":"key-10.4103\/1793-5482.243725-18","first-page":"371","volume-title":"Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: Prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy","author":"Chugh","year":"2009","journal-title":"J Neurosurg Pediatr"},{"key":"key-10.4103\/1793-5482.243725-19","first-page":"47","volume-title":"Endoscopic third ventriculostomy in post-tubercular meningitic hydrocephalus: A preliminary report","author":"Singh","year":"2005","journal-title":"Minim Invasive Neurosurg"},{"key":"key-10.4103\/1793-5482.243725-20","first-page":"851","volume-title":"A randomized study of ventriculoperitoneal shunt versus endoscopic third ventriculostomy for the management of tubercular meningitis with hydrocephalus","author":"Goyal","year":"2014","journal-title":"Childs Nerv Syst"},{"key":"key-10.4103\/1793-5482.243725-21","first-page":"245","volume-title":"Role of shunt surgery in pediatric tubercular meningitis with hydrocephalus","author":"Agrawal","year":"2005","journal-title":"Indian Pediatr"},{"key":"key-10.4103\/1793-5482.243725-22","first-page":"2","volume-title":"Mechanical complications in shunts","author":"Sainte-Rose","year":"1991","journal-title":"Pediatr Neurosurg"},{"key":"key-10.4103\/1793-5482.243725-23","first-page":"287","volume-title":"Outcome analysis of initial neonatal shunts: Does the valve make a difference?","author":"Robinson","year":"2002","journal-title":"Pediatr Neurosurg"},{"key":"key-10.4103\/1793-5482.243725-24","first-page":"248","volume-title":"Cerebrospinal fluid shunt survival and etiology of failures: A seven-year institutional experience","author":"McGirt","year":"2002","journal-title":"Pediatr Neurosurg"},{"key":"key-10.4103\/1793-5482.243725-25","first-page":"1210","volume-title":"Outcome analysis of Ventriculoperitoneal Shunt procedures in hydrocephalus due to Tubercular Meningitis and non-infective cases","author":"Tyagi","year":"2016","journal-title":"Int J Contemp Pediatr"},{"key":"key-10.4103\/1793-5482.243725-26","first-page":"254","volume-title":"Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus","author":"Kulkarni","year":"2009","journal-title":"J Pediatr"},{"key":"key-10.4103\/1793-5482.243725-27","first-page":"854","volume-title":"Ventriculoperitoneal shunt in post tubercular hydrocephalus","author":"Singh","year":"1996","journal-title":"Indian Pediatr"},{"key":"key-10.4103\/1793-5482.243725-28","first-page":"278","volume-title":"Role of neuroendoscopy in the management of patients with tuberculous meningitis hydrocephalus","author":"Husain","year":"2005","journal-title":"Neurosurg Rev"},{"key":"key-10.4103\/1793-5482.243725-29","first-page":"795","volume-title":"Endoscopic third ventriculostomy: Outcome analysis of 100 consecutive procedures","author":"Hopf","year":"1999","journal-title":"Neurosurgery"},{"key":"key-10.4103\/1793-5482.243725-30","first-page":"145","volume-title":"Radiological assessment of hydrocephalus: New theories and implications for therapy","author":"Greitz","year":"2004","journal-title":"Neurosurg Rev"},{"key":"key-10.4103\/1793-5482.243725-31","first-page":"431","volume-title":"A proposed model of cerebrospinal fluid circulation: Observations with radionuclide cisternography","author":"Greitz","year":"1996","journal-title":"AJNR Am J Neuroradiol"}],"container-title":["Asian Journal of Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.4103\/ajns.AJNS_107_18.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,15]],"date-time":"2022-09-15T00:02:07Z","timestamp":1663200127000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.4103\/ajns.AJNS_107_18"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12]]},"references-count":31,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2022,9,14]]},"published-print":{"date-parts":[[2018,12]]}},"URL":"https:\/\/doi.org\/10.4103\/ajns.ajns_107_18","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1793-5482","2248-9614"],"issn-type":[{"value":"1793-5482","type":"print"},{"value":"2248-9614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12]]}}}