Intraventricular Tuberculoma of the Central Nervous System: A Systematic Review of Clinical Presentation, Management, and Outcome

BACKGROUND AND OBJECTIVES: Tuberculosis remains a major global health burden, with central nervous system (CNS) involvement accounting for 1% to 10% of cases. Intraventricular tuberculoma is a distinct, poorly documented entity, separate from tuberculous meningitis with hydrocephalus. This systematic review assessed the epidemiology, diagnosis, management, and outcomes of CNS intraventricular tuberculoma. METHODS: PubMed and Scopus were searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for studies on CNS intraventricular tuberculoma (PROSPERO registration number CRD420251017978). Pooled data were summarized using measures of central tendency and dispersion. RESULTS: Of 841 records identified, 18 studies (17 case reports, 1 retrospective series) encompassing 30 patients were included. Patients were predominantly male (53.3%), with a median age of 24 years [IQR 11.5-31.8]. The median symptom duration before admission was 3 months [IQR 2-4]; headache (76.7%) and fever (66.7%) were the most common presenting symptoms. MRI was performed in 73.3% and computed tomography in 46.7% of cases. Hydrocephalus was present in 53.3% at diagnosis, and the tuberculoma was most often located in the lateral ventricle (46.7%). Antituberculous therapy alone was used in 56.7% of patients, while 43.3% received combined medical-surgical treatment; among the 13 patients treated surgically, microsurgical resection achieved gross total removal in 9 (69.2%). The median follow-up was 15.5 months [IQR 7.5-26.3], with favorable outcomes in 76.7% and mortality of 3.3%. CONCLUSION: Intraventricular tuberculoma is a rare, distinct manifestation of CNS tuberculosis strongly associated with hydrocephalus. Prompt recognition and individualized medical-surgical management are associated with favorable outcomes, although evidence remains limited to case-level reports, warranting confirmation through prospective, multicenter studies.