Endoscopic Transaqueductal Removal of Fourth Ventricular Neurocysticercosis With an Angiographic Catheter

Abstract

Transaqueductal removal of an intra-fourth ventricular cyst along with endoscopic third ventriculostomy with a rigid endoscope and catheter is an effective treatment and obviates the need for posterior cranial fossa exploration.

Uncommon Clinical Manifestations of Cysticercosis

“…[99,110,[115][116][117][118][119][120][121][122][123][124][125][126][127] and has been well established that available treatment options are: medical, external cerebro-spinal fluid diversion, microsurgical, or endoscopic removal alone or in combination. [122] Summarizing the reports in the medical literature we can conclude that the best choices for treatment of IVNCC are:…”

“…Albendazol (15 mg/kg/day for 2 weeks): A regimen of albendazole is the treatment of choice for IVNCC even after surgical procedures [122], although praziquantel may also be useful.…”

“…[116] 3. Direct surgical excision of the parasite after a shunt procedure is performed, [115] but the complication rate is high due to obstruction or material infection, which may justify other procedures such s endoscopic third ventriculostomy, [122] as you can read below. Resection of the fourth ventricle lesion through a sub occipital approach allowed for restoration of normal cerebro-spinal fluid (CSF) flow and relief of midbrain compression.…”

“…The flexible fiberoptic scope is used for excising cysts in the fourth ventricle, through a transaqueductal route and patients should be treated with albendazole in the postoperative period. [118,120,122] Endoscopic third ventriculostomy for patients with ventricular outlet obstruction and a prior history of FVNCC has been reported as a successful management and no patient has required subsequent surgery. [121,122] Endoscopic transaqueductal removal of fourth ventricular neurocysticercosis with an angiographic catheter has been used and there are good experiences from two series of 10 and 21 patients with IVNCC with obstructive hydrocephalus that underwent endoscopic removal along with endoscopic third ventriculostomy through a frontal precoronal burr hole.…”

“…[118,120,122] Endoscopic third ventriculostomy for patients with ventricular outlet obstruction and a prior history of FVNCC has been reported as a successful management and no patient has required subsequent surgery. [121,122] Endoscopic transaqueductal removal of fourth ventricular neurocysticercosis with an angiographic catheter has been used and there are good experiences from two series of 10 and 21 patients with IVNCC with obstructive hydrocephalus that underwent endoscopic removal along with endoscopic third ventriculostomy through a frontal precoronal burr hole. The author concluded that a 30-degree rigid telescope provide excellent image quality, with the ability to address intra-FVNCC through the dilated aqueduct with a curved-tip catheter without significant operative or postoperative complications.…”