Possible neurosurgical care to patients with central nervous system tuberculosis in a region with high prevalence of HIV infection

The study objective is to indicate conditions of various operative neurosurgical interventions in patients with tuberculosis / HIV co-infection. 

Materials and methods. Studied microbiological, radiological and histological characteristics in 682 patients treated, 331 deaths and 12 operated patients with central nervous system tuberculosis combined with HIV infection. Produced 15 operations: ventriculoperitoneal shunting on 3 patients, stereotactic biopsy on 7 patients, removal of inflammatory foci with a capsule on 5 patients.

Results. The indications for surgery in only 3 of 24 patients with hydrocephalus have all been a positive effect. The probability of detecting the pathogen of encephalitis biopsy is 71.4 %. All the radical operation for removal of the local formations of the сentral nervous system in conjunction with appropriate chemotherapy led to the recovery of patients.

Conclusions. When distributive of hydrocephalus in patients with combined pathology of conditions for the ventriculoperitoneal shunting are no reduction of hydrocephalus in the course of conservative treatment, the reduction of pleocytosis of cerebrospinal fluid under the effect of chemotherapy and positive result of the tap test. A biopsy of the brain in HIV infection are shown in order to clarify diagnosis and determine the range of drug susceptibility for the correction of chemotherapy. Conditions for radical removal of tuberculous formations of the brain in HIV infection are: the absence of a tendency to reduce the size of the formations under the influence of chemotherapy, prescribed within the spectrum of drug susceptibility of at least 2 months; the disappearance of the zone of perifocal edema around the lesion in the brain.

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