Surgery for intramedullary tuberculoma of the spinal cord: report of 2 cases

Abstract

Background: Intramedullary tuberculomas are rare. With the widespread availability of MRI and the increasing incidence of HIV and HIV-related tuberculous infections, the incidence of these lesions is likely to increase worldwide. The role of medical and surgical treatment of these relatively rare lesions remains to be defined. We report 2 patients who presented with intramedullary tuberculomas and discuss the importance of early surgery in this condition.

Case description: Two female patients presented with insidious onset of myelopathy. The first patient had seizures due to imaging-documented intracranial tuberculomata and progressive paraparesis due to an intramedullary tuberculoma. The second patient had also had insidious onset of myelopathy and evidence of an intramedullary tuberculoma in MRI. She was also found to have abdominal and pulmonary tuberculosis. In view of the presence of tuberculosis elsewhere in the body in both the patients and the classical imaging features of intramedullary tuberculoma, they were treated initially with antituberculous chemotherapy. However, despite chemotherapy, both patients did not show improvement. Subsequently, both patients underwent microsurgical removal of the intramedullary lesions. The first patient who was neurologically well preserved at the time of surgery improved, whereas the second patient who was paraplegic with sphincter disturbances did not show any improvement.

Conclusions: These case reports are presented to highlight the role of early surgery in patients with profound neurological deficits and intramedullary tuberculoma even if the radiological appearance of the lesion is characteristic. Even in lesions that are potentially curable by chemotherapy, early surgery has an important role in the treatment.