|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 5 | Page : 1465
Department of Neurosurgery, Director, Institute of Neurosciences and Spinal Disorders, MGM Healthcare, Chennai, Tamil Nadu, India
|Date of Submission||03-Nov-2020|
|Date of Decision||12-Feb-2021|
|Date of Acceptance||15-May-2021|
|Date of Web Publication||30-Oct-2021|
Department of Neurosurgery, Director, Institute of Neurosciences and Spinal Disorders, MGM Healthcare, Chennai - 600 029, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sridhar K. Cystic Tuberculoas. Neurol India 2021;69:1465
I read with interest the Neuro Image article in your journal reporting a cystic tuberculoma in the brain in a 11-year-old child. The first report of a cystic tuberculoma in literature was from India in a 4-year-old boy in 1962. Sinh et al. subsequently published their landmark article on the pathogenesis of unusual forms of intracranial tuberculomas.[23 In 2004, we reported two cases of cystic tuberculomas and at the same time proposed a classification of these rare lesions. The cystic tuberculomas were classified into four types depending on the relationship of the cyst to the tuberculoma and the surrounding brain. The possible causative mechanisms of the extralesional cysts include an exudative or inflammatory response to the infection or mechanisms similar to those involved in the development of peritumoural cysts associated with meningiomas and schwannomas. Intralesional cysts probably arise from the liquefaction of the caseous material of the tuberculoma. The cyst fluid is free of AFB but is high is protein and mononuclear cells.
The presence of a cyst with an enhancing wall means that it is an intralesional cyst and the wall would need to be excised as far as is possible. Extralesional cyst walls do not enhance and the wall does not need excision. In the case reported by Munakomi, there appears to be a combination of types 2 and 4 cysts, an intralesional peripheral and an extralesional between the lesion and the brain, which is unusual and has not been reported earlier.
As is well known, tuberculosis is a great mimicker and careful attention is needed when dealing with intracranial lesions associated with cysts.
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Conflicts of interest
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| » References|| |
Munakomi S. An interesting form of presentation in intracranial tuberculosis. Neurol India 2020;68:957-8.
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Dastur HM, Desai AD, Dastur DK. A cystic cerebral tuberculoma treated surgically. J Neurol Neurosurg Psychiatry 1962;25:370-3.
Sinh G, Pandya SK, Dastur DK. Pathogenesis of unusual intracranial tuberculomas and tuberculous space occupying lesions. J Neurosurg 1968;29:149-59.
Sridhar K, Ramamurthi B, Vasudevan MC. Cystic tuberculomas of the brain. Neurol Med Chir (Tokya) 2004;44:438-41.