Imaging features and surgery-related outcomes in intraventricular neurocysticercosis

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system, and its prevalence is continuing to increase in the United States. The diagnosis of intraventricular NCC (IVNCC) may be difficult, and surgery frequently fails to resolve symptoms. A retrospective review of magnetic resonance (MR) imaging characteristics and surgery-related outcomes may improve management strategies of this disease.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors report the presentations, neuroimaging characteristics, surgical management, and outcomes of 30 patients with IVNCC treated over a 10-year period (mean follow-up period 4 years). Cysts were located in the lateral ventricles (five cases), the third ventricle (five cases), and the fourth ventricle (21 cases). One patient had lesions in both the lateral and fourth ventricles. Presenting symptoms were related to hydrocephalus or mass effect from the lesions.</jats:p> <jats:p>All patients underwent computerized tomography (CT) and MR imaging of the brain. Treatment consisted of shunt implantation or primary excision of an IVNCC lesion. Outcomes after operations and reoperations were evaluated in light of enhancement characteristics on MR imaging.</jats:p> <jats:p>Computerized tomography scanning demonstrated IVNCC lesions in 10% of cases, and MR revealed lesions in 100% of cases. In patients in whom gadolinium (Gd) enhancement of IVNCC lesions was demonstrated on MR imaging, the surgery-related failure rate was higher and patients required reoperation, and in those in whom gadolinium enhancement was absent the surgery-related failure rate was lower (64 and 19%, respectively; p &lt; 0.0002).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Magnetic resonance imaging is superior to CT scanning for detecting IVNCC lesions. The absence of pericystic Gd enhancement on MR imaging is an indication for excision of the lesions. If pericystic enhancement is present, shunt surgery should be performed, and craniotomy reserved for treatment of those patients with symptomatic lesions secondary to mass effect. A treatment algorithm based on patient symptoms, cyst location, and MR imaging Gd enhancement characteristics is proposed.</jats:p></jats:sec>

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

“…The literature regarding the use of endoscopic excision of fourth ventricular cysticercosis is scarce (1, 2, 4,8,10,13,14). This is the first report of endoscopic transaqueductal removal of fourth ventricular cysticercosis with electrical flexible neuroendoscopy in China.…”

Uncommon Clinical Manifestations of Cysticercosis

“…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.…”

“…[114] Most studies have been addressed to review the therapeutic approaches of IVNCC, as can be seen in our review. [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:…”

Clinical Diagnoses of Neurocysticercosis

“…Headache and signs of intracranial pressure are more frequent in the extraparenchymal location [88%), in comparison with the parenchymal location (10%). [12] When cysticerci are located inside the ventricular system, life-threatening acute intracranial hypertension as a result of hydrocephalus may occur; as a consequence, severe headache, dizziness and consciousness alteration are the predominant clinical manifestations [5,27].…”