419 © Springer International Publishing AG 2017 M. Turgut et al. (eds.), Tuberculosis of the Central Nervous System, DOI 10.1007/978-3-319-50712-5_29 Hydrocephalus Surgery in Childhood Tuberculous Meningitis with Hydrocephalus Anthony Figaji, Graham Fieggen, and Ursula Rohlwink Contents 29.1 Introduction 419 29.2 Shunt Insertion for All Patients 421 29.3 External Ventricular Drainage First and then Shunt 422 29.4 Endoscopic Third Ventriculostomy for All Patients 423 29.5 Selection Based on Communicating Versus Noncommunicating Hydrocephalus, with Shunting, Endoscopy, and Medical Treatment as Options 423 29.6 Additional Considerations 426 Conclusion 427 References 427 Abbreviations CSF Cerebrospinal fluid ETV Endoscopic third ventriculostomy EVD External ventricular drain HIV Human immunodeficiency virus ICP Intracranial pressure MRI Magnetic resonance imaging SIADH Syndrome of inappropriate antidiuretic hormone TB Tuberculosis/tuberculous TBM Tuberculous meningitis 29.1 Introduction Hydrocephalus is common in tuberculous menin- gitis (TBM) and contributes to poor outcomes [1–4]. But its management is not necessarily as straightforward as hydrocephalus in other condi- tions. First, managing TBM patients well is not just about hydrocephalus treatment. Effective management must be focused as much on dealing with the other complications of TBM, such as vasculitis, as it is on the hydrocephalus itself. Second, it is not all about placing a shunt or not. If managed well, most patients can be spared life- long shunt dependency. These are important truths about TBM that are often overlooked. Unfortunately, we have little evidence to guide our therapies. No standardization exists for the treatment of hydrocephalus due to A. Figaji, MD, PhD (*) • G. Fieggen, MD U. Rohlwink, PhD Paediatric Neurosurgery Unit, Division of Neurosurgery, University of Cape Town, Cape Town, South Africa e-mail: Anthony.Figaji@uct.ac.za; gfieggen@gmail.com; ursulakarin@gmail.com 29