Posterior Fossa Craniotomy for Adherent Fourth Ventricle Neurocysticercosis

Franko, Lynze R.; Pandian, Balaji; Gupta, Avneesh; Savastano, Luis; Chen, Kevin S.; Riddell, James; Orringer, Daniel A.

doi:10.1093/ons/opy158

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…series,[ 2 ] 17 patients were treated with a primary posterior fossa approach and 6 of them had evidence of ependymitis and needed a CSF shunt. Other case reports[ 10 15 ] also describe a good outcome with a microsurgical posterior fossa approach. Nevertheless, complications such as periventricular edema, residual fourth ventricle cyst, fourth ventricle entrapment, need for reoperation and hematomas have been reported[ 5 18 20 ] and should be considered.…”

Section: Discussionmentioning

confidence: 94%

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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Section: Discussionmentioning

confidence: 94%

Fourth ventricle neurocysticercosis: A case report

Simão¹,

Teixeira²,

Campos³

et al. 2018

Surg Neurol Int

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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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