Endoscopic Approach to Intraventricular Cysticercal Lesions

Abstract

Various surgical approaches to treat intraventricular cysticercosis have been practiced over the years. We now present our experience with the use of the endoscope in the removal of intraventricular cysticercal cysts in patients with intraventricular cysticercal lesions associated with hydrocephalus. From 1995 to 1998, we have excised intraventricular cysticercal cysts from 9 patients. They were located in lateral ventricle in 4, in the third ventricle in two and in the fourth ventricle in three patients. A Gaab's rigid neuroendoscope system was used to enter and excise cysts in the lateral and third ventricle. The flexible fiberoptic scope was used for excising cysts in the fourth ventricle, through a transaqueductal route. In all cases a precoronal frontal burr hole was used for entry. All have been treated with albendazole in the postoperative period. All the cysts were removed successfully using endoscopic neurosurgery alone. One patient had a superficial injury to the rigid side of the aqueduct with a postoperative deficit, which improved. Three septal perforations, three third ventriculostomies, and one aqueductoplasty were done in the same sitting after cyst removal for CSF diversion. None of the nine cases required further surgery up to date. The follow-up period varied from 12 to 45 months with a median of 18 months. Endoscopic neurosurgery is a minimally invasive technique enabling removal of intraventricular cyticercal cysts from all locations, avoiding major craniotomies/posterior fossa explorations and shunts.

Endoscopic approach to fourth ventricle cysticercosis

“…Two of these two were permanent 27,28 . Anandh et al 26 described a right transfrontal approach using a rigid endoscope to enter the lateral and third ventricle and to remove fourth ventricle cysts in three patients, followed by a standard third ventriculostomy, like we performed with our case. The authors removed the cystic lesions in all patients with no mortality and a case evolving with transient hemiparesia and ocular ptosis probably to lesion of the periaqueductal region.…”

“…Endoscopic approaches for intraventricular neurocysticercosis has been described recently 7,[23][24][25][26] . Proaño et al performed an endoscopic exploration of fourth ventricle that showed a ventricle inflamatory entrapment secondary to ependymitis 8 .…”

Uncommon Clinical Manifestations of Cysticercosis

“…[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:…”

“…[162] Although they have also reported irreversible spinal injuries by NCCIm that logically do not recover with surgical intervention. [141] Finally, there are individual differences from the clinical point of view, imaging and of response to treatment according to the number and location of the lesions, that determine the characteristics of the presentations described [117,161] and which are by describing such as: medullary central cord syndrome, medullary conus and the horsetail, when this happens. In the meantime, report of isolated cases continues to unfold with more or less variations between the same.…”

“…[169] Finally, there are individual differences from the clinical point of view, imaging and of response to treatment according to the number and location of the lesions, that determine the characteristics of the described presentations. [117,160] Neurocysticercosis is always present in patients with DCC.…”