Calvarial tuberculosis: Uncommon manifestation of common disease - a series of 21 cases

Objective. Tuberculosis is an endemic disease in developing countries like India. It can involve almost any part of human body. One such, albeit rare, is the extra pulmonary manifestation tuberculosis of calvaria. There have been many isolated case reports and short series published on this unusual presentation. The aim of this presentation is to acquaint the reader with the varied presentation; to emphasise the role of prompt surgical debridement; as also to stress the role of complete antitubercular drug therapy in the management of this rare disease. Methods. A retrospective analysis of a total of 21 patients over a period of 10 years period (July 1995 to June 2005). All patients were screened for the evidence of primary pulmonary tuberculosis. As part of their radiological workup, they were subjected to either a CT scan head or MRI brain. All patients were surgically managed at the institute. ATT was prescribed for 18 months. Follow-up period ranged from 6 months to 8 years. Results. All patients improved following the completion of therapy with no evidence of recurrence. Conclusion. Calvarial tuberculosis is endemic in developing countries. This disease mainly affects the young population. With the rising incidence of AIDS, neurosurgeons all over the world are more likely to be exposed to this disease. CT head and MRI brain is the mainstay for radiological diagnosis. Definitive diagnosis rests on a biopsy report. Surgical debridement followed by anti-tubercular therapy for 18 months is the mainstay of the management of this unusual presentation.