Shunting in hydrocephalus due to tuberculous meningitis. Cases presenting with high cerebrospinal fluid proteins in pediatric age

Aim. Management of hydrocephalus due to tuberculous meningitis is still a challenging issue. High concentrations of cerebrospinal fluid proteins and elevated cell counts will affect ventricular shunt function. The aim of this prospective study was to evaluate the results of shunt function in cases having high concentrations of cerebrospinal fluid proteins. Methods. Between January 1995 and January 2001, 84 children were treated with the diagnosis of tuberculous meningitis in Istanbul Pediatric Clinics. Hydrocephalus occurred in 32 (38%) of them. The cerebrospinal fluid samples obtained from these patients via lumbar puncture, ventricular puncture or trapping of the shunt pumps in operated patients and analyses included protein electrophoresis and differential cell counts. Results. Mean cerebrospinal fluid protein level was 236 mg/dL (range 26-643 mg/dL) and mean cell count was 36/mm? (range 12-132/mm?) with a dominancy of the lymphocytes (70-90%). Protein electrophoresis consisted of low molecular weight proteins with a mean of 93.1% (range 85.7-96.7%). The average follow-up period was 45 months (range 26-67 months). All the clinical and radiological findings of hydrocephalus showed a regression after die shunt operations, despite the worries of shunt dysfunction pre-operatively. The cerebrospinal fluid proteins level and cell counts had dramatically declined with neurological improvements after shunt insertion. Conclusion. This prospective study showed that in certain limits, covering mostly low molecular weighted proteins like albumin, prealbumin, even high cell counts in cerebrospinal fluid, does not affect shunt function.