Surgical treatment and operation time in HIV-negative cryptococcal meningitis

Abstract Background: There are still no unified guidelines of surgical treatment and timing for HIV-negative patients with cryptococcal meningitis (CM). Methods: The clinical data and follow-up data were collected from HIV-negative CM patients in Xiangya Hospital of Central South University from January 2009 to November 2018, and 42 patients who were treated with surgical intervention were enrolled in the present study. These 42 patients were divided into ventriculoatrial (VA) group, ventriculoperitoneal (VP) group, external ventricle drainage (EVD) group, hydrocephalus (HYC) group, non-HYC group, EVD group and non-EVD group (VA/VP) according to different surgical procedures. Statistical analyses were conducted using SPSS (version 19.0, Chicago, IL, USA). Results: Signs of headache, fever and loss of consciousness in the VA group were significantly improved compared with the EVD group at 1 week after operation (P<0.05). The mortality rate of the VA group was significantly lower than that of the EVD group (P<0.05). Moreover, male patients were more prone to have HYC (P<0.05). Younger patients tended to develop HYC (P<0.05). Cerebrospinal fluid (CSF) sugar in the non-HYC group was significantly lower compared with the HYC group (P<0.05). Time of CM-to-operation in the non-HYC group was markedly shorter compared with the HYC group (P<0.01). Conclusions: VA procedure could be one of the first choices for the treatment of uncontrollable intracranial hypertension caused by CM. Severe uncontrollable headache, loss of consciousness and cerebral hernia were indications of emergency surgery. Repeated headache, hearing impairment, and especially progressive loss of vision were indications of early surgery to avoid permanent damage to nerve functions of HIV-negative CM patients.