Cysticercosis of the central nervous system: I. Surgical treatment of cerebral cysticercosis. A 23 years experience in the hospital das clínicas of Ribeirão Preto Medical School

Abstract

SUMMARY -Cysticercosis is the most frequent parasitosis of the nervous system and nowadays it is widespread through the world. Despite the development of anticysticercal drugs (praziquantel and albendazole), their efficacy is more marked in cases with parenchymal active cysts and they do not prevent complications such as hydrocephalus. Thus, many patients with neurocysticercosis require surgical intervention, generally of palliative nature, but that may occasionally produce a cure. The clinical outcome of 180 patients with cerebral cysticercosis who underwent srugical treatment form 1970 to 1993 was analised. Surgical treatment was performed to control increased ICP in 177 patients and due to local compression of cranial nerves or brainstem in five. Some patients had more than one surgical procedure, totalizing 287 interventions. Increased intracranial pressure (ICP) was caused by hydrocephalus in 91 %, by intracranial mass lesion (tumoral form) in 6.2% and by pseudotumor cerebri (pseudotumor^ form) in 2.8% of the case. Based on the pathophysiological mechanisms of intracranial hypertension identified through conventional CT-scan, ventriculography, cisternotomograpy, ventriculotomography and MRI, different surgical approaches were indicated. Patients with tumoral form were submitted to direct approach and cyst removal and generally they had benefits from this procedure. Patients with pseudotumor^ form whose clinical treatment failure underwent decompressive craniectomies and had a poor outcome (40% of good results). Direct removal of ventricular/ cisternal cysts and/or ventriculoatrial/peritoneal shunting (VA/VPS) was performed in patients with hydrocephalus. Removal of free ventricular cysts in patients who had no ependimitis/arachnoiditis generally allowed a good outcome. Patients with adherent cysts and inflammatory process nedeed a VA/VPS posteriorly and the outcome was not so good. One hundred thirty-two patients were submitted to VA/VPS (109 as the first procedure and 23 after another surgical treatment). The VA/VPS was effective to control increased ICP, despite many complications observed mainly during the two first postoperative years. After this period the surviving patients generally had a better outcome. The patients submitted to cyst removal due to local compression of cranial nerves/brainstem generally had good results. Based on the experience acquired with the management of these patiens we present our recent policy for the treatment of patients with neurocisticercosis. nos cistos ativos parenquimatosos. Além disso, essas drogas não previnem complicações como a hidrocefalia. Portanto, número considerável de pacientes requer intervenções cirúrgicas, geralmente paliativas, mas que excepcionalmente podem ser curativas. Foram analisadas as evoluções clínicas de 180 pacientes com cisticercose cerebral tratados cirurgicamente no período de 1970 a 1993. A cirurgia foi indicada para controlar a hipertensão intracraniana (HIC) em 177 pacientes e para remover compressão local de nervos cranianos ou do tronc...

Cysticercosis-related mortality in the State of São Paulo, Brazil, 1985-2004: a study using multiple causes of death

“…Knowledge of the associated causes opens new prospects for preventing deaths. The fact that intracranial hypertension, hydrocephalus, cerebral edema, and inflammatory diseases of the CNS were the principal associated causes is consistent with a study on cysticercosis-related mortality in California 8 and with clinical case reports and autopsy reports in Brazil 3,4,6,7 . Associated causes classified as terminal, such as pneumonia, septicemia, shock, and coma, reflect the severity of the cysticercosis disease process leading to death.…”

“…It is reasonable to posit that nonspecific sanitation measures and improved schooling and socioeconomic conditions may have caused this drop in incidence. Meanwhile, the reduction in case-fatality would likely be related to more effective health care, including early diagnosis, medication, and (neuro)surgical treatment 3,5 , as reflected in the increasing median age at death observed in this study.…”

“…Almost 50,000 deaths attributable to neurocysticercosis occur every year. The severity of cysticercosis can also be illustrated by its case-fatality rate, varying from 16.4% to 25.9% 1,2,3,4,5,6 .…”

Endoscopic management of cysticercal cysts within the lateral and third ventricles

“…Because a CSF diversionary procedure leaves the intraventricular cyst in situ, the death of the cyst can provoke ependymitis and arachnoiditis [7,13,21,29] and, therefore, worsen the prognosis significantly. [16,35] In addition, a degenerating cyst can dramatically increase in size, causing a local mass effect [7,8] and/or a compartmentalized hydrocephalus.…”

Dificultades diagnósticas y terapéuticas en la neurocisticercosis: presentación de 6 casos y revisión de la literatura

“…Se considera que las lesiones quísticas con efecto de masa, clínica de HTIC y déficits neurológicos, son candidatas a cirugía 11,26 . El volumen de la lesión y la clí-nica de HTIC fue lo que determinó la opción quirúrgica en nuestros casos 1 y 4.…”