Endoscopic transaqueductal removal of fourth ventricular neurocysticercosis: report of three cases

Abstract

In this study, we try to present our experience of transaqueductal removal of the fourth ventricular neurocysticercosis (FVNCC) with a flexible neuroendoscope. Three cases of the fourth ventricular cysticercosis were transaqueductally removed with FUJINON EB-270P flexible neuroendoscope through a frontal precoronal burr hole. The diagnosis was established on imaging and confirmed on histology in all of the cases. Complete excision of cysts in the fourth ventricle was performed in all cases with no significant intraoperative or postoperative complications. The shunt and the string-of-beads multiple cysts in the basal cistern were removed simultaneously through the orificium fistulae of the third ventricle floor with the flexible neuroendoscope. Satisfactory postoperative CSF flow around foramen magnum was detected by cine phase-contrast magnetic resonance imaging. All of the patients were asymptomatic, with an average follow-up of 6 months. The whole ventricular system can be explored easily with electrical flexible neuroendoscope. Endoscopic transaqueductal removal of the fourth ventricular cysticercosis with a flexible neuroendoscope should be recommended as the optimal choice of the disease due to its minimal invasion, fewer complications, shorter length of stay and cheaper treatment costs. KEywords: Fourth ventricular, Neurocysticercosis, Endoscopic transaqueductal removal, Treatment ÖZÇalışmada esnek bir nöroendoskopla dördüncü ventrikül nörosistiserkozisinin transakuaduktal eksizyonuyla ilgili deneyimimizi sunuyoruz. Üç adet dördüncü ventrikül sistiserkozis olgusu, bir frontal prekoronal burr deliği içinden FUJINON EB-270P esnek nöroendoskopuyla transakuaduktal olarak çıkarıldı. Tüm olgularda tanı görüntülemeyle kondu ve histolojiyle doğrulandı. Dördüncü ventriküldeki kistlerin tam eksizyonu tüm olgularda herhangi bir önemli intraoperatif veya postoperatif komplikasyon olmadan gerçekleştirildi. Bazal sisterndeki boncuk dizisi tarzındaki çoklu kistler ve şant, esnek nöroendoskopla üçüncü ventrikül tabanındaki fistül orifisi yoluyla aynı anda çıkarıldı. Sine faz-kontrast manyetik rezonans görüntüleme yoluyla foramen magnum etrafında tatminkar postoperatif BOS akışı gözlendi. Ortalama takip 6 aydı ve hastaların hiçbirinde belirti yoktu. Elektrikli esnek nöroendoskopla tüm ventriküler sistemin eksplorasyonu kolayca yapılabilir. Esnek bir nöroendoskopla dördüncü ventrikül sistiserkozisinin endoskopik transakuaduktal yoldan çıkarılması minimum invazyon, daha az komplikasyon, hastanede daha az kalma ve daha ucuz tedavi maliyeti nedeniyle bu hastalık için optimum tercih olarak düşünülmelidir.

Revised diagnostic criteria for neurocysticercosis

“…We also conducted a literature review looking for reported cases with surgical/ histopathological confirmation of ventricular cysticercosis during the past 20 years. A total of 21 papers describing 29 patients, where case descriptions and neuroimaging findings were appropriately detailed as to apply our set to diagnostic criteria, were found [35,37,[56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74]. Despite the fact that most of these patients did not had a serum EITB performed, the set allowed a definitive pre-operative diagnosis of NCC in 23 cases (one absolute criterion in 12, two major neuroimaging in six, and one major neuroimaging plus one confirmative in five), and a probable diagnosis in the remaining six patients.…”