Characteristics and surgical outcomes of tuberculous meningitis and of tuberculous spondylitis in pediatric patients at Dr. Hasan Sadikin Hospital, Bandung: A single center experience

Abstract

Introduction: Tuberculous meningitis (TBM) and tuberculous spondylitis (TBS) are the form of extra-pulmonary tuberculosis. Material and method: A retrospective cohort study was conducted among children with TBM (2009–2014) and TBS (2004–2014) who were treated in our center; Department of Child Health, Department Neurosurgery and Department Orthopedics. Results: Of 123 children diagnosed with TBM (53) and TBS (70); based on modified British Medical Research Council: Stage I (3 cases), Stage IIa (3 cases), Stage IIb (23 cases), Stage III (24 cases). TBM developed hydrocephalus: 36 cases performed ventriculoperitoneal shunt and 17 cases external ventricular drainage. In TBM: 9.4% (5/53) had vegetative state and mortality rate was 20.8% (11/53). TBM Hospital discharge correlated with Glasgow coma scale preoperation (p<0.001). In TBS: Thoracic spine was involved in 67.1% cases, Lumbar in 28.6% and Cervical in 4.3%. Of 70 cases: 45 cases with neurological deficit and 25 cases without one. Of 24 cases underwent spine surgery: 6 cases performed anterior decompression spinal fusion and 18 cases performed posterior debridement with stabilization. In TBS patients, mortality rate was 1.4% (1/70). Conclusions: The surgical outcomes of both TBM and TBS still poor in many ways. Improving TB outcomes as implementation of the End TB Strategy program at 2030 remain our homework. Keywords: Surgical outcomes, Tuberculous meningitis, Tuberculous spondylitis