Document Detail


Rate of resolution of histologically verified intracranial tuberculomas.
MedLine Citation:
PMID:  14519219     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The goal of this study was to determine the rate of radiological resolution of histopathologically proven tuberculomas treated with antituberculous therapy (ATT). The effects of the size of the tuberculomas, the number of tuberculomas, and the addition of corticosteroid therapy on the rate of resolution of the tuberculomas were also studied. METHODS: Twenty-eight patients (age range, 5-48 yr; 14 male and 14 female patients) with histologically proven intracranial tuberculomas were prospectively monitored with contrast-enhanced computed tomographic scans. The patients received ATT consisting of rifampicin and isoniazid for a period of 18 months, with ethambutol and/or pyrazinamide for a minimum of 3 months. Fifteen patients also received corticosteroid therapy for 1 to 6 weeks. Of the 28 patients, 17 patients underwent partial excision, 6 underwent open biopsy, and 5 underwent stereotactic biopsy of their tuberculomas. RESULTS: Kaplan-Meier analysis revealed that, after 9 months of ATT, only 18.2% of the patients demonstrated complete resolution of their tuberculomas; even after 18 months of ATT, 69.2% of the patients had residual lesions. By 24 months, 54% of the patients demonstrated complete resolution of their tuberculomas. Although the number of tuberculomas, corticosteroid administration, prior treatment with ATT, and the duration of symptoms before presentation (<6 mo versus >6 mo) did not influence the rate of resolution, larger tuberculomas (maximal size, >4 cm) were observed to resolve more slowly than smaller tuberculomas (<4 cm) (P = 0.02). CONCLUSION: More than two-thirds of patients with partially excised or biopsied intracranial tuberculomas exhibited persistent lesions on computed tomographic scans, even after 18 months of ATT. Therefore, the duration of ATT for patients with intracranial tuberculomas should be based on the radiological responses of the tuberculomas. Our data suggest that some patients with intracranial tuberculomas might require prolonged periods of ATT.
Authors:
Santosh Isaac Poonnoose; Vedantam Rajshekhar
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  53     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2003 Oct 
Date Detail:
Created Date:  2003-10-01     Completed Date:  2003-11-06     Revised Date:  2008-02-21    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  873-8; discussion 878-9     Citation Subset:  IM    
Affiliation:
Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, India. rajshekhar@cmcvellore.ac.in
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenal Cortex Hormones / therapeutic use
Adult
Antitubercular Agents / administration & dosage,  therapeutic use*
Biopsy / methods
Child
Child, Preschool
Drug Administration Schedule
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Prospective Studies
Stereotaxic Techniques
Tomography, X-Ray Computed
Treatment Outcome
Tuberculoma, Intracranial / drug therapy*,  pathology,  radiography,  surgery
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Antitubercular Agents
Comments/Corrections
Comment In:
Neurosurgery. 2005 Apr;56(4):E873   [PMID:  15818884 ]
Neurosurgery. 2005 Mar;56(3):E629   [PMID:  18235261 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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