Introduction: Central nervous system tuberculosis (CNS TB) is the most lethal manifestation of tuberculosis. An estimated 90,000 cases of CNS TB presented in 2010 and worldwide prevalence is currently on the rise. The aim of this study was to identify the best treatment strategy for CNS tuberculoma through a summary of treatment modalities and overall patient outcome ascertained from the published literature.
Methods: We conducted an English language literature search of CNS tuberculoma. Institutional experiences and case reports were included through March 2012. Recorded parameters included patient age, spinal or intracranial tuberculoma, surgical and medical treatment, clinical outcome, and duration of follow up.
Results: 47 cases of CNS tuberculoma were identified in the literature. Mean age at presentation was 32.7 years. The location of 17 cases of tuberculoma was intracranial and 22 cases were located in the spine; 6 presented with tuberculous meningitis. Surgical resection of the mass lesions was performed in 26/47 (55%) and anti-tuberculosis chemotherapy was administered in 46/47 (98%) for an average duration of 9 months. Clinical improvement was observed in 22/26 surgical cases (85%) and 30/34 of patients treated with anti-tuberculosis medication (88%), including complete resolution of lesions and symptoms, with a mean follow up time of 10 months. One patient with spinal tuberculoma was treated successfully with total surgical excision alone.
Conclusions: Obtaining a biopsy is essential for diagnosis and appropriate treatment of CNS tuberculoma as less invasive diagnosis is challenging and indefinitive. Neurosurgical referral is essential in cases of CNS TB with intracranial hypertension, and surgical excision may prove beneficial in relieving symptoms in intraventricular and intramedullary tuberculomas.
Patient Care: By reviewing treatment and patient outcome in existing cases, this research will help define an optimal treatment plan for best results in future patients.
Learning Objectives: 1) Describe the importance of early diagnosis and treatment in central nervous system tuberculoma.
2) Discuss, in small groups, the relevant findings of this study, and present interesting questions to be addressed in future investigation.
3) Identify an effective treatment strategy for intracranial and spinal tuberculomas.
References:  WHO. Global Tuberculosis Control 2011. In: WHO, ed. World Health Organization. Geneva; 2009:1-258.