Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Case Report Pediatr Neurosurg 2007;43:42–46 DOI: 10.1159/000097525 Endoscopic Third Ventriculostomy in Prepontine- Suprasellar Tuberculoma with Tuberculous Meningitis Hydrocephalus: A Case Report Deepak Jha a Prakash Khatri a Ajay Choudhary a Rajeev Sethi b Sushil Kumar a Departments of a Neurosurgery and b Radiology, St. Stephens Hospital, Tishazari, Delhi, India Introduction Tuberculous meningitis hydrocephalus (TBMH) is a known complication of tuberculous meningitis. Various modalities of treatment are available, including conser- vative treatment with dehydrants, external shunt and ex- ternal ventricular drain with or without external shunt. Recently, endoscopic third ventriculostomy (ETV) has been found effective in TBMH, and an increasing num- ber of neuroendoscopists are offering ETV to such pa- tients [1–7]. To date, factors affecting the outcome of ETV in TBMH are not identified. In our earlier study, we in- cluded 1 case each of suprasellar/third ventricular tuber- culoma and tubercular abscess over the third ventricular roof; however, premamillary regions were not involved in either of these patients [5] . There is no report on endo- scopic treatment of prepontine-suprasellar tuberculoma involving the premamillary region. Here, we present a case with thick basal exudates, considered as exclusion criteria in our earlier report, and discuss our findings. Case Report A 5-year-old male child presented with a low-grade fever, pro- gressive headache and vomiting for the last 3 months. Acute ex- acerbations of symptoms were noted by the parents 3 days before admission to our hospital and he was admitted in an unconscious Key Words Endoscopic third ventriculostomy  Hydrocephalus  Tuberculous meningitis Abstract We present a case of prepontine-suprasellar tuberculoma in- volving the premamillary region of the third ventricular floor, a site suitable to perform an endoscopic third ventriculos- tomy (ETV) stoma, managed endoscopically, and discuss our findings. A 5-year-old male child was admitted in an uncon- scious state with a history of gradually progressive symp- toms of raised intracranial pressure and low-grade fever for the last 3 months. Head computed tomography showed thick enhancing basal exudates, a prepontine-suprasellar ring-enhancing lesion with consequent obstructive hydro- cephalus. The child was subjected to urgent endoscopy which revealed multiple ependymal tubercles along with prepontine-suprasellar tuberculoma involving the pre- mamillary region of the third ventricular floor. The tubercu- loma was decompressed using a 5-french catheter, and ETV was performed. Postoperatively, the child improved clinico- radiologically on antitubercular chemotherapy and needed no further cerebrospinal fluid diversion surgery; he is under regular follow-up. We conclude that ETV may be attempted even in the presence of thick basal exudates and/or prepon- tine-suprasellar tuberculoma. Copyright © 2007 S. Karger AG, Basel Received: September 26, 2005 Accepted after revision: February 9, 2006 Dr. Deepak Jha St. Stephens Hospital Tishazari, Delhi 110054 (India) Tel. +91 98119 66623, Fax +91 11239 32412 E-Mail jhadeepak2@rediffmail.com © 2007 S. Karger AG, Basel 1016–2291/07/0431–0042$23.50/0 Accessible online at: www.karger.com/pne