CT-guided stereotactic surgery in the management of intracranial tuberculomas

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Abstract
CT-guided stereotactic techniques were used in the management of 21 patients (22 procedures) with intracranial tuberculomas. In 17 patients CT-guided stereotactic surgery was performed to obtain a diagnosis; 10 patients with small superficial lesions or masses in eloquent areas had an excision biopsy following CT-guided stereotactic craniotomies (Group A); seven patients underwent a closed stereotactic biopsy (Group B). Four patients (five procedures) with previously proven tuberculous disease had stereotactic aspiration of a cystic tuberculous mass (Group C). All patients in Group A had a definite histological diagnosis of a tuberculoma. Of the seven in Group B, a definitive diagnosis was obtained in two; in four patients the biopsy showed evidence of chronic inflammation; and in one the procedure was abandoned due to venous hemorrhage. All patients in Group C had amelioration of their symptoms following aspiration of the contents of the cystic mass. There was transient operative morbidity in two patients. There was no procedure-related permanent disability or mortality. CT-guided stereotactic biopsy being minimally invasive, is ideally suited for the management of deep-seated intracranial tuberculomas as they can be treated medically once a diagnosis is secured. A diagnosis of chronic inflammation obtained on CT-guided stereotactic biopsy, in correlation with the clinical and radiological findings, often provides confirmatory evidence of a tuberculoma in a patient with an intracranial mass. It also rules out a neoplasm and avoids empiric therapy of brain masses. Stereotactic localization techniques also help avoid possible morbidity associated with the excision of superficial small tuberculomas from eloquent areas.