A prospective observational study of tuberculous meningitis with hydrocephalus in Sarawak, Borneo

Authors

  • Siew-Hong Yiek 1 Department of Surgery, Neurosurgery Unit, Universiti Malaya, Kuala Lumpur, Malaysia
  • Yu-Wei Heng Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia. Department of Neurosurgery, Sibu Hospital, Sibu, Malaysia.
  • Nelson Kok-Bing Yap Department of Neurosurgery, Sibu Hospital, Sibu, Malaysia
  • Albert Sii-Hieng Wong Department of Neurosurgery, Sarawak General Hospital, Kuching, Malaysia
  • Kamal Azrin Bin Abdullah @Kalai Arasu A/L Muthusamy Department of Surgery, Neurosurgery Unit, Universiti Malaya, Kuala Lumpur, Malaysia

DOI:

https://doi.org/10.54029/2025zrk

Keywords:

tuberculous meningitis, hydrocephalus, CSF diversion, external ventricular drainage, ventriculoperitoneal shunt

Abstract

Background: The incidence of hydrocephalus is high in patients with tuberculous meningitis (TBM). Over the past 20 years, studies have shown a tendency to use ventriculoperitoneal shunt (VPS) to treat all patients with TBM and hydrocephalus.

Methods: A prospective observational study was conducted in Sarawak, Borneo (Sibu Hospital and Sarawak General Hospital) from 2019 to 2022. This study aimed to identify patients who would benefit from VPS by assessing Modified Rankin Scale (MRS) post-treatment, survival rate, and various prognostic factors.

Results: 30 cases were recruited and classified using Modified Vellore Grading (MVG). There was no significant difference between the first month and final post-treatment outcomes. However, mortality rates among poor-grade patients increased significantly after the first month. This study followed up on all surviving patients until 31/5/2024, with a follow-up period of 26 to 63 months. We only performed VPS if there was at least a one-grade improvement in MVG or GCS. Despite VPS, mortality rates remained high, particularly among patients with poor grades, specifically MVG 3 and 4. The study also found that baseline MVG or GCS, cerebrospinal (CSF) protein levels, and the presence of infarcts had a statistically significant effect on patient outcomes.

Conclusion: Poor-grade patients often have cerebral infarcts in addition to hydrocephalus. We recommend an extended external ventricular drainage trial of 5 to 7 days as a preliminary procedure for VPS selection in poor-grade patients. This approach allows for a more objective identification of patients who are most likely to benefit from permanent CSF diversion.

Published

2025-12-28

Issue

Vol. 30 No. 4 (2025)

Section

Original Article