Calvarial Tuberculosis: Shifting Paradigm from Surgical to Conservative Approach

Vivek Kumar, Varun Aggarwal, Gopal Krishna, Ishwar Singh, Vinay Vinay, Praveen S. Holkar
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Abstract

Background Tuberculosis (TB) is an endemic disease in developing countries like India. However, incidence of calvarial TB is very low and it presents in varied forms posing a diagnostic dilemma and delay in management. Objectives This article reports a case series of 15 patients with varied presentations of calvarial TB from a tertiary care superspeciality center of Haryana state in India. Material and Methods Study is a retrospective analysis of 15 patients with calvarial TB treated between 2018 and 2021 in a tertiary care hospital. Clinical features, radiological findings, surgical and medical management, and outcomes were reviewed. Results Of the 15 patients, 9 were males and age ranged between 12 and 45 years. Mean duration of symptoms was 2.9 months (range 1–5 months). The most common presenting symptoms were scalp swelling, discharging sinus, and pain. Four patients were treatment defaulters of pulmonary TB and two patients were found human immunodeficiency virus positive. Brain imaging showed peripherally enhancing extradural collection with bone erosions in most cases. Eleven patients were managed conservatively with fine-needle aspiration cytology (FNAC) or local debridement/sinus excision. Four patients were managed surgically with drainage of collection, excision of necrotic bone, followed by antitubercular therapy. One patient needed cerebrospinal fluid diversion for associated hydrocephalous with tubercular meningitis which could not recover and succumbed. Conclusion Calvarial TB is a rare occurrence of common prevalent diseases. Conservative management with FNAC and sinus excision followed by antitubercular treatment are the mainstay of treatment. Surgery should be reserved for extensive lesion or lesion with mass effect.
颅骨结核:从手术治疗到保守治疗的范式转变
背景 结核病(TB)是印度等发展中国家的地方病。然而,钙化性肺结核的发病率非常低,而且表现形式多种多样,造成了诊断上的困境和治疗上的延误。本文报告了印度哈里亚纳邦一家三级医疗超级专科中心 15 例表现各异的钙化性肺结核患者的系列病例。材料与方法 研究是对一家三级医院在 2018 年至 2021 年间收治的 15 例钙化性肺结核患者的回顾性分析。研究回顾了临床特征、放射学检查结果、手术和内科治疗以及结果。结果 15名患者中有9名男性,年龄在12至45岁之间。平均病程为 2.9 个月(1-5 个月)。最常见的症状是头皮肿胀、鼻窦分泌物增多和疼痛。四名患者为肺结核治疗失败者,两名患者发现人类免疫缺陷病毒阳性。脑部成像显示,大多数病例的硬膜外集合体周围增强,并伴有骨侵蚀。11 名患者接受了保守治疗,进行了细针穿刺细胞学检查(FNAC)或局部清创/窦道切除术。四名患者接受手术治疗,引流积液,切除坏死骨,然后进行抗结核治疗。一名患者因伴有脑积水和结核性脑膜炎,需要进行脑脊液转流,但未能痊愈,最终不治身亡。结论 钙骨结核是一种罕见的常见病。治疗的主要方法是采用 FNAC 和窦道切除术进行保守治疗,然后进行抗结核治疗。手术应保留给广泛病变或有肿块效应的病变。
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