Surgical treatment of cerebral cysticercosis: long-term results and prognostic factors

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Cysticercosis is the most frequent parasitosis of the central nervous system. Although anticysticercal drugs have proven efficient in some cases, many patients with NCC require palliative, occasionally curative, surgical procedures. The authors analyzed the data and prognostic factors obtained during the follow-up period (range 1–255 months, median 38 months) in 160 patients with cerebral cysticercosis who underwent surgical treatment.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Different surgical approaches were indicated to control increased intracranial pressure (ICP) in most patients, and some patients had undergone decompressive surgery for local brain lesions. Most patients required more than one surgical procedure. Statistical analysis was performed using the Fisher exact, the log-rank, and the Kruskall–Wallis tests. Survival curves were calculated according the Kaplan–Meier method. The removal of a giant cyst from the parenchyma or cisterns for relief of increased ICP and for chiasm/optic nerve decompression improved most symptoms in patients. The removal of ventricular cysts was effective in the control of increased ICP in most patients. Patients with a ventricular cyst and ependymitis/arachnoiditis required placement of a ventriculoperitoneal (VP) shunt after the cyst was removed. This therapy effectively controlled increased ICP. Patients younger than 40 years of age at the time of treatment and male patients had worse outcomes. The outcome in patients who underwent VP shunt surgery or shunt surgery combined with reservoir implantation was worse than that in those who underwent cyst removal alone. Shunt-related infection was the most frequent complication, and the global mortality rate during the follow-up period was 21.2%. Although both complications were more frequent in the first 2 postoperative years, they occurred at any time.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Long-term prognosis in patients with cerebral cysticercosis who required surgery was not good. Cysts located in the basal cisterns and patient age younger than 40 years were poor prognostic factors.</jats:p></jats:sec>

Therapy for neurocysticercosis

“…The role of surgical therapy in the management of NCC has significantly decreased over time and surgery is now mainly restricted to the placement of ventricular shunts for hydrocephalus secondary to NCC and for eventual cases of accessible intraventricular or racemose subarachnoid cysts [11,15,25,42].…”

“…Acute cysticercotic encephalitis, which is unresponsive to corticosteroids and mannitol, may require temporal lobe resection [11]. Optic chiasm arachnoiditis may require surgical débridement of adhesions and decompression.…”

“…Solitary cysts which cause uncontrollable seizures or significant mass effect and spinal cysticerci should be surgically excised if they are accessible [11]. Acute cysticercotic encephalitis, which is unresponsive to corticosteroids and mannitol, may require temporal lobe resection [11].…”

“…Cysticerci developing in the ventricles or subarachnoid space usually reach a larger size and often take on the form of racemose cysticerci, which are characterized by a membrane of irregular thickness and the absence of a scolex. They are usually clustered into multiple interconnected vesicles, resembling a cluster of grapes [7,11,12].…”

Surgical treatment of neurocysticercosis. Retrospective cohort study and an illustrative case report

“…4 Even after degeneration of the cysticercus, the irritant remains and the patient might become epileptic. 9 Therefore, epilepsy is the most frequent symptom of the parenchymal type. 1,9 In the extraparenchymal form, in which an obstruction occurs at some point of the CSF flow (Figures 1 and 2), patients may present signs and symptoms of intracranial hypertension secondary to hydrocephalus.…”