Stereotactic approach for tuberculoma that simulates brain stem tumor. Case report and literature review.

Abstract

Introduction: We present a case of tuberculoma approached by stereotactic surgery mimicking space occupying lesions of brainstem; the published literature was reviewed and the importance of this procedure in the diagnosis and treatment of such lesions was enphatized.
Clinical case: A 49 year old male patient without personal patological history with symptoms of occipital throb and intense headache, accompanied by deficits symptoms of low cranial base pairs, paresthesia and left motor brachiocrural deficit. The imaging findings showed a commitment of the brain stem by annular lesion, enhancement with the contrast´s administration. It was surgically approached by stereotactic surgery with total excision of the lesion without complications and positive post-operative recovery. The histopathological diagnosis evidenced a tuberculoma.
Conclusions: Even though the brainstem is a less common location of Neurological manifestations of tuberculosis on the central nervous system and in the absence of a tuberculosis history, even though no history of bacilar infection is found, a tuberculoma should be included in the differential diagnosis of the space occupying lesions in this region, due to its ability to mimic these lesions and its impact on and its much higher frequency on developing countries. Although the imaging differences are not defined between this type of lesions and the malignant neoplasm, the stereotactic surgery should be considered as a diagnostic tool and therapeutic alternative, for its advantages are less invasive and equally effective reaching an accurate diagnosis and an early treatment based on a histopathological criteria and of clinical suspicion.