Turkish Neurosurgery 2010 , Vol 20 , Num 3
Diagnostic and Therapeutic Role of CT-Guided Stereotactic Surgery in the Management of Intracranial Tuberculomas
Mehmet ERSAHIN1, Tayfun HAKAN2, Erdogan AYAN3, Zafer BERKMAN4, Osman EKINCI5, Nurgul CERAN6, Fugen VARDAR AKER7
1,2,3,4Haydarpasa Numune Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
5Haydarpasa Numune Education and Research Hospital, Department of Anesthesiology, Istanbul, Turkey
6Haydarpasa Numune Education and Research Hospital, Department of Infectious Disease, Istanbul, Turkey
7Haydarpasa Numune Education and Research Hospital, Department of Pathology, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN.3071-10.1 AIM: CT-guided stereotactic methods have long been used for the diagnosis and treatment of intracranial masses. Intracranial tuberculoma is a rare form of extrapulmonary tuberculosis. Histological confirmation is the gold standard for a correct diagnosis. However, histopathological diagnosis and excision of these lesions have advantages over open surgical methods. This study presents our experience on the use of stereotactic biopsy and excision in the management of intracranial tuberculomas.

MATERIAL and METHODS: Thirteen patients with intracranial masses underwent stereotactic procedures for tissue samples to establish histopathological diagnosis. In 6 suitable patients, stereotactic microsurgical excision was performed for both diagnostic and therapeutic purposes, whereas only stereotactic biopsy was conducted in the remaining subjects.

RESULTS: The tuberculoma diagnosis was established in 12 out of 13 cases (92%). Seizure control was achieved in all patients admitted with a history of seizures. There was no procedure-related mortality, none of the patients suffered permanent disability and most procedures were uneventful. Total resection without any residual mass was done. All patients responded to antituberculous treatment with complete lesion disappearance.

CONCLUSION: These findings suggest that CT-guided stereotactic surgery of intracranial tuberculomas has advantages over other methods, with a potential to become the first-line modality, particularly as a diagnostic tool, in the management of these lesions. Keywords : Tuberculoma, Stereotactic surgery, Management Histopathological diagnosis

Corresponding author : Mehmet Ersahın, drmehmetersahin@gmail.com