Intracranial Tuberculoma

Series from different parts of the world revealed that tuberculomas constitute from 0.5% to 30% of central nervous system space occupying lesions. The immigrant from endemic areas, appearance of resistant strain of Mycobacterium tuberculosis, immune deficiency syndrome patients, poverty malnutrition, overcrowding have the potential to increase the number of patients. This study discusses 30 cases of intracranial tuberculoma managed either conservatively by medical treatment only (6 cases) or surgically by total or partial excision through craniotomy or craniectomy (20 cases). Excision biopsy was one in 3 cases, also VP shunt was done in 2 case, one alone and another with craniectomy. We discuss the cases as regard neurological assessment, investigation and management. Indications of surgery were mass effect, hydrocephalus, neurological deterioration, doubt diagnosis, cases not respond to medical treatment. We found that no superiority of medical or surgical management, although the function recovery is better in surgical group than medical group patients. In this study the outcome is better in young patients, with short duration of symptoms, absence of papilloedema, lower disability level before management, absence of mass effect and smaller sizes of lesions. We recommend excision biopsy in suspicious cases not respond to medical treatment for 6 weeks if surgery not indicated from the start of the diagnosis.