Guiding neurosurgical intervention in tuberculous meningitis: evaluation of clinical features, laboratory parameters, and outcomes with a treatment algorithm
- 1Division of Adult Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila
- 2Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila
- 3College of Pharmacy, University of the Philippines Manila
Abstract
Tuberculous meningitis (TBM) remains a major cause of central nervous system infection in endemic regions and is frequently complicated by hydrocephalus requiring cerebrospinal fluid (CSF) diversion. Timely surgical decision-making is critical, particularly in resource-limited settings. The objective of this study was to characterize the clinical profile and management of TBM in a tertiary center and retrospectively validate a logistic regression–based model for guiding surgical intervention in TBM-associated hydrocephalus. A retrospective review was conducted on 175 adult patients with TBM admitted to the Philippine General Hospital from January 2021 to May 2025. Clinical, laboratory, and radiologic data were analyzed. The predictive model was applied to determine its diagnostic performance in identifying patients requiring surgical intervention. The mean age of our patients was 37 ± 15 years, with male predominance (n = 107, 61%). Most patients (n = 147, 84%) presented with Modified Vellore grades 3–4, and hydrocephalus was observed in 70% (n = 122). CSF diversion was performed in 30% of cases (n = 53). Overall mortality was 44% (n = 77), primarily due to septic shock and brain herniation. The model demonstrated good discriminative ability (Area Under the Curve 0.84, 95% CI 0.71–0.86). A recalibrated g-score threshold of > 0.20 from the original 0.04 improved diagnostic balance (sensitivity 91.2%, specificity 60.8%, positive predictive value 32%, negative predictive value 96%). Altered sensorium (OR 6.89) and persistent headache (OR 4.26) were the strongest predictors of surgery. The validated model provides a simple and clinically practical framework for guiding surgical decision-making in TBM-associated hydrocephalus, with potential utility in resource-limited settings.
Related
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BibTeX
@article{naoe2026guiding,
title = {{Guiding neurosurgical intervention in tuberculous meningitis: evaluation of clinical features, laboratory parameters, and outcomes with a treatment algorithm}},
author = {Ena Elizabeth L. Naoe and Edmund John B. Cayanong and Safrollah M. Guinal and Kurt Joshua E. Baladjay and John Rex C. Butial and Frances Lois U. Ngo and Juan Silvestre G. Pascual and Kathleen Joy O. Khu and Julette Marie F. Batara and Roland Dominic G. Jamora},
journal = {Scientific Reports},
year = {2026},
month = jul,
doi = {10.1038/s41598-026-62905-5},
url = {https://doi.org/10.1038/s41598-026-62905-5},
note = {CC BY},
}
RIS
TY - JOUR
TI - Guiding neurosurgical intervention in tuberculous meningitis: evaluation of clinical features, laboratory parameters, and outcomes with a treatment algorithm
AU - Ena Elizabeth L. Naoe
AU - Edmund John B. Cayanong
AU - Safrollah M. Guinal
AU - Kurt Joshua E. Baladjay
AU - John Rex C. Butial
AU - Frances Lois U. Ngo
AU - Juan Silvestre G. Pascual
AU - Kathleen Joy O. Khu
AU - Julette Marie F. Batara
AU - Roland Dominic G. Jamora
PY - 2026
DA - 2026/07/01
JO - Scientific Reports
DO - 10.1038/s41598-026-62905-5
UR - https://doi.org/10.1038/s41598-026-62905-5
AB - Tuberculous meningitis (TBM) remains a major cause of central nervous system infection in endemic regions and is frequently complicated by hydrocephalus requiring cerebrospinal fluid (CSF) diversion. Timely surgical decision-making is critical, particularly in resource-limited settings. The objective of this study was to characterize the clinical profile and management of TBM in a tertiary center and retrospectively validate a logistic regression–based model for guiding surgical intervention in TBM-associated hydrocephalus. A retrospective review was conducted on 175 adult patients with TBM admitted to the Philippine General Hospital from January 2021 to May 2025. Clinical, laboratory, and radiologic data were analyzed. The predictive model was applied to determine its diagnostic performance in identifying patients requiring surgical intervention. The mean age of our patients was 37 ± 15 years, with male predominance (n = 107, 61%). Most patients (n = 147, 84%) presented with Modified Vellore grades 3–4, and hydrocephalus was observed in 70% (n = 122). CSF diversion was performed in 30% of cases (n = 53). Overall mortality was 44% (n = 77), primarily due to septic shock and brain herniation. The model demonstrated good discriminative ability (Area Under the Curve 0.84, 95% CI 0.71–0.86). A recalibrated g-score threshold of > 0.20 from the original 0.04 improved diagnostic balance (sensitivity 91.2%, specificity 60.8%, positive predictive value 32%, negative predictive value 96%). Altered sensorium (OR 6.89) and persistent headache (OR 4.26) were the strongest predictors of surgery. The validated model provides a simple and clinically practical framework for guiding surgical decision-making in TBM-associated hydrocephalus, with potential utility in resource-limited settings.
SN - 2045-2322
ER -