# Large Tuberculous Mass Lesions Involving the Brain: Outcomes and Management

## TL;DR

This study examines the outcomes of treating large tuberculous brain lesions with antituberculous therapy alone or combined with steroids or surgery.

## Contribution

The study provides insights into the effectiveness of different treatment combinations for large tuberculous brain lesions.

## Key findings

- Antituberculous therapy alone achieved a 76.9% favorable outcome rate.
- Adding steroids or surgery did not significantly improve outcomes compared to antituberculous therapy alone.
- Median modified Rankin Scale improved from 2 at baseline to 1 at 6 months.

## Abstract

The optimal management of large tuberculous mass lesions (LTML) involving the central nervous system remains unclear. We conducted a single-center, retrospective, observational study that assessed the outcomes of patients with LTML from January 2010 to February 2023. An LTML was defined as a tuberculoma or tubercular abscess exceeding or equal to 3 cm. The primary outcome was independence in activities of daily living, as assessed by the modified Rankin Scale (mRS) at a follow-up of 6 months. Forty-six patients were identified during the study period. Their mean age was 27.6 ± 12 years, the median duration of antituberculous therapy (ATT) was 18 months, and the median duration of follow-up was 20 months (interquartile range 15.7–40). The favorable outcomes were 76.9% (10/13) for ATT alone, 62.5% (10/16) for ATT with steroids, 87.5% (7/8) for ATT with surgery, and 66.9% (6/9) for ATT, steroids, and surgery. The median mRS at baseline in the study was 2 (1–3), and at the 6 month follow-up, it was 1 (0–2). Adding steroids or surgical intervention to ATT did not significantly improve primary outcomes (P = 0.637). Further large-scale studies are necessary to confirm these preliminary observations.