Table 2.

Studies including VP shunt or ETV in patients with TBMH

S NO.	Study	VPS/ETV	Outcome	Complication	Remark
1	Lampre-ht et al.[6] 2001	VPS	Total 65 TBMH cases (4–131 months), 38 (noncommunicating) and 27 (communicating) Good outcome: 55.4% cases Mortality: 12.5% cases	Shunt-related complication: 32.3% cases Shunt infection: 13.5% cases Shunt obstruction: 13.5% cases	VPS has a high complication rate in TBMH compared with non-tubercular hydrocephalus shunt surgery
2	Husain et al.[14] 2005	ETV ± Monroplasty/ septostomy	Total 28 cases (5 months, 68 years) of TBMH Outcome: Overall success rate of 68% (19/28) Satisfactory: 50% (14/28) cases Acceptable: 18% (5/28) cases Unsatisfactory: 32% (9/38) cases	Complication rate: 10% CSF leak: two cases Perioperative bleed: one case	He suggested that ETV should be the first surgical option in TBM with communicating hydrocephalus, as outcome was satisfactory (50%) and VP shunt surgery was reserved for cases with ETV failure.
3	Agrawal et al.[7] 2005	VPS± EVD	37 pediatric cases (<18 years) with TBMH Good outcome: 43% (16/37) Moderate disability: 35% (13/37) Severe disability: 16% (6/37) Overall, 62% children in Grade II had good outcome compared with 40% in Grade III All children in Grade III had poor outcome	Complication rate: 30% Three children had shunt revision multiple times	Recommend shunt placement in all children of Grade II and III of TBMH. For Grade IV, external ventricular drainage (EVD) followed by shunting, if improvement occurs, remains the most cost-effective procedure.
4	Jha et al.[15] 2007	ETV	14 patients with TBMH ETV was successful in 64.2% (9/14) cases.		ETV is likely to fail in the presence of advanced clinical grade, extra CNS tuberculosis, dense adhesions in prepontine cistern, and unidentifiable third ventricular floor anatomy.
5	Srikantha et al.[8] 2009	VPS ± EVD	95 cases of TBMH (Grade IV) Favorable short-term outcome: 33% cases Favorable long-term outcome: 45% cases		They suggested that direct VP shunt placement is an effective option in patients with Grade IV TBMH, and VP shunt should be considered even in patients who do not exhibit improvement with an EVD.
6	Chugh et al.[16] 2009	ETV	26 cases of TBMH (7 months, 52 years) Overall success rate was 73.1%. Outcome was better in those cases who were treated with ATT preoperatively for a longer period and it was poor during a higher stage of illness.		They suggested that ETV should be considered as the first surgical option for CSF diversion in patients with TBM with hydrocephalus.
7	Yadav et al.[17] 2011	ETV	59 cases (6 months, 76 years) of TBM with obstructive hydrocephalus. Successful outcome: After ETV alone, 58%. After ETV with lumboperitoneal shunt: 80%.	Blocked stoma: 5.1% cases Malnutrition: 53% Complex hydrocephalus: 22% cases	ETV was safe and effective in TBMH cases. Complex hydrocephalus and associated cerebral infarct were the major cause of failure to improve. Good results were observed in better grades. ETV was considered the first‑choice treatment in the chronic burnout phase of the disease and in obstructive hydrocephalus. Controversy existed about the role of ETV in the acute phase of the disease and in communicating hydrocephalus.
8	Peng et al.[9] 2012	VPS ± EDV	19 children (one month, 14 years) with TBMH (Grade IV) Full recovery: 21% (4/19) Slight sequelae: 42% (8/19) Severe sequelae : 21%(4/19) Overall success rate: 63% Mortality: 15% (3/19)	Complication rate was 32% (6/19)	They demonstrated that direct VP shunt placement could improve the outcome in Grade IV TBMH. The response to EVD is not a reliable indication for selecting the patients who would benefit from shunt surgery.
9	Singh et al.[18] 2005	ETV	35 cases of TBMH (6 months, 32 years) Grade I (6) Grade II (7) Grade III (22) The overall success rate of ETV was 77%. Overall, 60% of patients had early recovery and 17% of patients had delayed recovery. Success rate was 87% in patients with thin transparent floor of the third ventricle.		The presence of a thin and transparent floor of the third ventricle seemed to be associated with a higher success rate of 87%.
10	Savardek-ar et al.[19] 2013	ETV	Overall, 26 cases of TBMH. TBMH Grade III: 21 TBMH Grade IV: 5. After 3 months: In TBMH Grade III Good outcome: 71.4% (15/21) Mortality: 9.5% (2/21). In TBMH Grade IV Good outcome: 20% (1/5) Overall good outcome: 61.5% Mortality: 60% (3/5).	Complication rate: 23.5% (6/26)	Their opinion was that direct VP shunt placement is a safe and effective option even in poor-grade patients of TBM with hydrocephalus, with a low complication rate.
11	Goyal et al.[10] 2014	VPS and ETV each in 24 cases.	48 pediatric cases with TBMH (<18 years). In the VPS group, successful outcome was 68%. In the ETV group, it was 42%. ETV failure was more in the young age group (<2 years)		The relative risk of ETV failure is higher than that for shunt, but the risk becomes progressively lower with time. Therefore, if patients survive the early high-risk period, they could experience long-term survival advantage devoid of lifelong shunt-related complications.
12	Kankane et al.[11] 2016	VPS	50 pediatric cases (3 months, 14 years) with TBMH Grade III and IV (40 & 10). In TBMH Grade III, outcome and mortality were 77.5% and 0%, respectively. In Grade IV, outcome and mortality were 30% and 10%, respectively. Overall outcome: 68%	Complication rate was 10%.	They suggested the direct placement of the VP shunt in Grade III and IV cases with TBMH without intervening in EVD, and the result was good with a low complication rate.
13	Aranha et al.[12] 2018	VPS or ETV each in 26 cases	52 pediatric patients with TBMH (<18years). Success rate in the ETV group: 65.4% (17/26). In the VP shunt group: 61.54% (16/26). Failure rate in the ETV group: 34.6% (9/26) In the VP shunt group: 38.4% (10/26). Two cases of mortality were seen in each group.	In the ETV group, one case had CSF leak. In the VPS group, shunt malfunction was seen in seven cases and shunt infection was seen in three cases.	They found comparable ETV results in communicating hydrocephalus and obstructive hydrocephalus, and they suggested that it can be performed effectively in communicating hydrocephalus, high CSF cell counts, and protein levels, despite an indistinct third ventricular floor anatomy. So, ETV should be attempted as the first-choice CSF diversion procedure in hydrocephalus secondary to TBM where technical expertise and experience with this procedure is available.
14	Figaji et al.[20] 2007	ETV	17 pediatric patients with TBMH (<12years). Success rate: 41% (7/17). Failure rate: 29% (5/17). In five patients, ETV could not be completed due to abnormal anatomy	Two cases had CSF leak. Thus, complication rate was 11%.	Although ETV is technically possible in this situation, it is imperative that the patients are adequately selected for the procedure to ensure optimal treatment and that the surgeon has experience with difficult cases.
15	Sil and Chatterjee et al.[13] 2008	VPS	32 pediatric patients with TBMH (<12years). Palur Grade II: 22 (62.5%). Palur Grade III: 12 (37.5%). Good outcome: 8 (25%) children. Moderate disability (cognition and ocular motility disorders): 15 (46.9%) children. Severe disability: 5 (15.6%) children. Vegetative state: 1 (3.2%) and death: 3 (9.3%) children.	Shunt infection: 5 (15.6%). Shunt revisions due to blockade: 14 (43.8%) patients.	Their opinion was that the VP shunt will remain as the only armamentarium in the arsenal of the neurosurgeon for treating this disease even if it gets replaced by third ventriculostomy in the treatment of other forms of hydrocephalus.