Current Role of Surgery in the Treatment of Neurocysticercosis

Abstract

Neurocysticercosis (NCC) is a common parasitic disease of the central nervous system (CNS) in low- and middle-income countries. The infection is pleomorphic, caused by the larval form of the cestode, Taenia solium, and part of the heterogeneity of its clinical presentations is associated with the localization of the parasite within the CNS. Changes in the current epidemiological trends of NCC indicate that extra-parenchymal NCC is proportionally becoming more frequent. Extraparenchymal NCC is commonly accompanied by raised intracranial hypertension due to hydrocephalus, which is an emergency requiring cyst extirpation by surgical intervention to relieve the symptoms. Although less frequent, parenchymal cysts may also reach giant sizes requiring urgent surgical treatment. Finally, there is an advancement in the comprehension of the association between NCC and epilepsy—and patients with drug-resistant seizures are candidates for surgical treatment. In this narrative review, we summarize the present state of knowledge to update the current trends in the role of surgery in the treatment of NCC.

Concurrent Extraparenchymal and Spinal Neurocysticercosis in an Immunocompetent Patient Treated for Obstructive Hydrocephalus and Spinal Cord Compression

“…Multiple studies have described hydrocephalus occurring at onset of disease in 16-51% of patients with NCC, though this increases to closer to 64-72% in patients with the extraparenchymal form. [21][22][23][24]46] This patient was found to have developed obstructive hydrocephalus and was treated initially with EVD placement and eventual VP shunting. Cruz.…”

“…[46] This procedure has been used in the treatment of NCC related hydrocephalus and is an additional option for treatment in this regard, though it does have risk of failure in some cases due to pronounced inflammatory reactions which can lead to the close of the ostomy site. [46] Hamamoto Filho et al provided additional considerations surrounding the surgical treatment of NCC with regard to the surgical removal of cysts [46]As discussed earlier, endoscopic tools have allowed for additional means of treating conditions such as NCC, so when surgeons are performing the endoscopic third ventriculostomy they are able to extract intraventricular cysts during the operation. [46] Depending on the locations of cysts there are several options which can be used for cyst extraction.…”

“…[46] Hamamoto Filho et al provided additional considerations surrounding the surgical treatment of NCC with regard to the surgical removal of cysts [46]As discussed earlier, endoscopic tools have allowed for additional means of treating conditions such as NCC, so when surgeons are performing the endoscopic third ventriculostomy they are able to extract intraventricular cysts during the operation. [46] Depending on the locations of cysts there are several options which can be used for cyst extraction. Cysts which are located within the lateral and third ventricles can be extracted using rigid endoscopes, while cysts within the fourth ventricle can be managed with flexible endoscopes.…”

“…Cysts which are located within the lateral and third ventricles can be extracted using rigid endoscopes, while cysts within the fourth ventricle can be managed with flexible endoscopes. [46] Though fourth ventricle cysts can also be extracted via telovelar approach posterior fossa craniotomy. [46] Jang et al documented a case of recurrent primary spinal NCC in which the patient had previously only received surgical therapy, concluding that subarachnoid NCC is more optimally treated with the combination of surgery and medication, such as albendazole.…”

“…[46] Though fourth ventricle cysts can also be extracted via telovelar approach posterior fossa craniotomy. [46] Jang et al documented a case of recurrent primary spinal NCC in which the patient had previously only received surgical therapy, concluding that subarachnoid NCC is more optimally treated with the combination of surgery and medication, such as albendazole. [3] Patients that are found to have spinal NCC commonly are found to have concurrent intracranial disease and it is believed that it is due to larval migration through the ventricular system.…”