Surgical Therapy of Tuberculosis of the Nervous System and Its Coverings

Abstract

Tuberculosis (TB) of the central nervous system (CNS) can cause meningitis, epidural abscess, subdural empyema, brain abscess, and intraspinal abscess. Underlying predisposing conditions that lead to the development of TB of the CNS are often associated with some form of immunosuppression. The prognosis for these infections is often related to the extent of the disease and the neurological state of the patient at the time of diagnosis. Cranial and spinal involvement due to TB can be suspected on laboratory and imaging studies, but biopsy may be required to establish a definitive diagnosis. Once the diagnosis is established, prolonged treatment with anti-TB therapy is necessary to eradicate the cranial or spinal infection with inflammatory markers being followed to monitor the response to therapy. Failure to respond to medical management may lead to repeat drainage or resection of intracranial suppuration. Spinal TB is usually treated medically although surgery is indicated for confirmed instability, pronounced deformity, and neurological deficit.