Surgical nuances of giant neurocysticercosis according to intracranial location in the Southwest region of the Dominican Republic, presentation of cases, and literature review

Abstract

Background: Neurocysticercosis (NCC) is the most common infestation of the central nervous system, caused by the larval stage of the pig tapeworm Taenia solium. It is prevalent in regions with poor sanitation and underdevelopment, such as Latin America. Case Description: We present four cases in which they harbored an intraventricular/intraparenchymal, frontal convexity, cerebellomedullary, and intraparenchymal NCC cyst of medium size, respectively. Three of them underwent complete removal of the cyst by craniotomy; the fourth had a shunt for obstructive hydrocephalus first, followed by excision of a suboccipital cyst 8 months later. Conclusion: The intraventricular/intraparenchymal lesion was more complex to treat than its subarachnoid counterparts because the average brain should be transected and dissected away to achieve total removal. Waterjet dissection, arachnoid microdissection, and cyst drainage allowed minor brain damage than capsule coagulation and traction. Populated prospective studies are needed better to understand the surgical nuances of these rare entities.

Current Role of Surgery in the Treatment of Neurocysticercosis

“…Finally, it is relevant to mention that some parenchymal cysts may require surgical removal, particularly giant cysts with significant mass effects leading to raised intracranial pressure [ 77 , 78 ]. Patients with giant cysts may be admitted to emergency departments with signs of rapid neurological deterioration and, in these cases, surgical removal is more advisable than anthelminthic treatment, which could deteriorate symptoms (due to inflammation) and take several days to reduce the cyst size ( Figure 6 ).…”