Caught in the act: migrating intraventricular neurocysticercosis causing intermittent unilateral hydrocephalus due to foramen of Monro obstruction

Rana, Shaleen; Prasad, Abhishek; Brar, Rahat; Rathore, Deepander Singh; Dwivedi, Ankur

doi:10.1007/s13760-017-0831-6

Cited by 7 publications

(4 citation statements)

References 7 publications

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“…Bruns syndrome, described in 1906, occurs due to free cysts in the ventricular cavity. [10][11][12][13][14] There are reports of both endoscopic surgery 15,16 and open suboccipital approaches [17][18][19][20] for 4th ventricular NCC, with good surgical and functional results. Minimally invasive endoscopic excision requires experience, particularly in cases with a thin aqueduct 16,18,21,22 or if the cyst adheres to the ependymal lining.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic surgery for neurocysticercosis of the 4th ventricle: illustrative cases

Saavedra

Vásquez

Garcı́a

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Neurocysticercosis, caused by the larval stage of Taenia solium, affects the cerebral ventricles in 20–30% of cases and may lead to hydrocephalus and other neurological morbidity. Conventional treatment for cysts in the 4th ventricle includes open surgery (suboccipital approach) and neuroendoscopy, with the latter being the option of choice. Stereotactic surgery, minimally invasive, offers a good alternative for this type of deep lesion. OBSERVATIONS The authors report the cases of two women, 30 and 45 years old, who presented with headache, dizziness, and ataxia and were diagnosed with 4th ventricle cysticercosis. Magnetic resonance imaging (MRI) revealed dilated 4th ventricles (approximately 2.5 cm in both cases, with cystic images inside the ventricular cavity). Both patients were treated with stereotactic surgery via a suboccipital transcerebellar approach. Cyst material was extracted, and the diagnosis was confirmed by pathological examination. The surgeries had no complications and resulted in clinical improvement. Control MRI scans showed reduction of the volume of the ventricle without residual cysts. LESSONS Minimally invasive stereotactic surgery provided a safe alternative for 4th ventricle neurocysticercosis cysts, with more benefits than risks in comparison with conventional techniques.

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Section: Discussionmentioning

confidence: 99%

Stereotactic surgery for neurocysticercosis of the 4th ventricle: illustrative cases

Saavedra

Vásquez

Garcı́a

et al. 2021

Journal of Neurosurgery: Case Lessons

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“…The possibility of mobile cysticerci within the ventricular space had already been reported. [ 7 23 25 ] In addition, preoperative MRIs showed periventricular changes [ Figure 1 ], which could mean some degree of ependymitis, a known factor for hydrocephalus. [ 5 22 ] Therefore, we assumed that the surgical excision of the cyst might not treat the hydrocephalus and decided to perform a ventriculostomy in addition to the lesion removal.…”

Section: Discussionmentioning

confidence: 99%

Fourth ventricle neurocysticercosis: A case report

Simão¹,

Teixeira²,

Campos³

et al. 2018

Surg Neurol Int

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Background:Neurocysticercosis (NCC) is the most common helminthic disease of the nervous system in humans and it is caused by the larvae of the pork tapeworm, Taenia solium. We present a case of microsurgical removal of a fourth ventricle NCC cyst combined with an endoscopic third ventriculostomy (ETV) to treat hydrocephalus.Case Description:A 36-year-old woman presented to the emergency room with headache and decreased visual acuity over the last 4 months. A brain magnetic resonance imaging showed obstructive hydrocephalus apparently correlated to a mobile, cystic lesion of the fourth ventricle. In the same operative time, an ETV and a suboccipital craniotomy were performed in order to remove the lesion and to treat the hydrocephalus. The cyst was completely removed and pathologically identified as a T. solium cyst. The early postoperative course was uneventful and she was discharged asymptomatic and off anthelmintic medication. Five weeks later, the patient returned with hydrocephalus recurrence and was successfully retreated with an ETV. At 5-month follow-up, she remains asymptomatic and has no evidence of persistent disease or hydrocephalus recurrence.Conclusion:Intraventricular neurocysticercosis is, typically, a surgical disease. For cysts located on the fourth ventricle, a suboccipital craniotomy and a telovelar approach remains a valid option. Cyst removal does not necessarily resolve the hydrocephalus problem. ETV offers an option to the classic shunt placement approach and was shown to be effective even on hydrocephalus recurrence.

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“…Surgical removal of a single cyst is considered the end of treatment. Any suspicion of the existence of multiple cysts requires antihelminthic therapy [61]. It is not recommended to install antiparasitic drugs before surgery because they lead to parasite disruption, which may be accompanied by an inflammatory response of the adjacent tissue and compromise of surgical removal of the cyst [57].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Intraventricular Neurocysticercosis: Comparative Analysis of Different Localizations. Clinical Course and Treatment. A Systematic Review.

milenkovic,

Momcilovic,

Ignjatovic

et al. 2023

J Neurol Surg A Cent Eur Neurosurg

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Background Neurocysticercosis is significant due to its high prevalence and considerable morbidity and mortality. The intraventricular form of NCC is less common than parenchymal, may have a rapidly progressive course and it requires a corresponding therapeutic response. Despite the extensive literature dealing with NCC and intraventricular cystic lesions, no systematic reviews have addressed similar work related to the clinical course and treatment of the infestation. Our main objective was to analyze the clinical type of the disease and the management for each ventricle separately on the basis of case reports or series of patients with individual data on the course of the disease and its treatment. As a control group, we used data on signs&symptoms and treatment of patients from published series on intraventricular neurocysticercosis. Method We performed a search in the Medline database. Google Scholar was also randomly searched. We extracted the following data from the eligible case/series: age and gender, symptoms, clinical signs, diagnostic examinations and findings, localization, treatment, follow-up period, outcome, and publication year. All data are presented in the form of absolute and relative numbers. The frequency of signs and symptoms, treatment and outcomes of the observed groups were checked by the Chi-square test and Fisher's test. The hypothesis was tested with p <0.05 as statistical significance. Results We selected 160 cases of intraventricular neurocysticercosis (IVNCC) and divided them according to their localization into five categories. Hydrocephalus was recognized in 134 cases (83.4%). Patients with isolated IVNCCare are younger (P=.0264) and have a higher percentage of vesicular cysts (p <.00001). In mixed IVNCC, degenerative and multiple confluent cysts predominate (p = 0.00068). Individuals carrying fourth + third ventricular cysts (potentially obstructive form) are younger than individuals with lateral ventricles (potentially less obstructive forme) (p = .0083). The majority of patients had individual symptoms for a longer period before the acute onset of the disease (p <.00001). The predominant clinical manifestation is headache (88.7%); the proportion within the groups ranged from 100% to 75% without statistical significance (p.074214). The same was true for patients with symptoms of vomiting or nausea, who had a lower and roughly balanced percentage of 67.7% to 44.4% (p.34702). Altered level of consciousness (ranging from 21% to 60%) and focal neurological deficit (from 51.2% to 15%) are the only clinical category with statistical significance (p <0.001 and p.023948 ). Other signs and symptoms were less frequent and statistically irrelevant. Surgical resection of the parasite was the predominant type of treatment, varying from 55.5% to 87.5% (p- .02395); endoscopy (48.2%) and craniotomy (24.4%), each individually, showed statistical significance (.00001 and .000073, respectively). The difference was also relevant among patients who had CSF diversion performance with/without medical treatment (p-.002312. Postoperatively, 31.8% of patients received anthelmintics with/without anti-inflammatory or other drugs. Endoscopy, open surgery, and postoperative antiparasitic therapy showed statistical differences (p < 0.001). Favorable outcomes or regression of symptoms were recorded in 83.7%, mortality 7.5%. In the case series, the clinical signs&symptoms were as follows: headache-64%, nausea and vomiting 48.4%, focal neurological deficit 33.6% and altered level of consciousness 25%. Open surgery was the predominant form of intervention (craniotomy (57.6% or endoscopy 31.8%); with statistical significance between them (p< .00001). Conclusion. Ventricular neurocysticercosis is an alarming clinical condition. Hydrocephalus is the dominant diagnostic sign. Isolated IVNCC patients were recognized at a younger age than Mix.IVNCC individuals; poeple with cysts in the fourth and third ventricles (as a potentially more occlusive type of disease), presented their symptoms at a younger age than individuals with LVNCC. The majority of patients had long-term signs and symptoms before the acute onset of the disease. Headache, nausea& vomiting are the most common symptoms of infestation accompanied by altered sensorium and focal neurological deficits. Surgery is the best treatment option. A sudden increase in ICP due to cerebrospinal fluid obstruction with a successive cerebral hernia is the leading cause of fatal outcomes.

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Caught in the act: migrating intraventricular neurocysticercosis causing intermittent unilateral hydrocephalus due to foramen of Monro obstruction

Cited by 7 publications

References 7 publications

Stereotactic surgery for neurocysticercosis of the 4th ventricle: illustrative cases

Stereotactic surgery for neurocysticercosis of the 4th ventricle: illustrative cases

Fourth ventricle neurocysticercosis: A case report

Intraventricular Neurocysticercosis: Comparative Analysis of Different Localizations. Clinical Course and Treatment. A Systematic Review.

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