Child's Nervous System

, 25:1467

Intraventricular and subarachnoid basal cisterns neurocysticercosis: a comparative study between traditional treatment versus neuroendoscopic surgery

  • Jefferson V. Proaño
  • Jaime Torres-Corzo
  • Roberto Rodríguez-Della Vecchia
  • Gabriel Guizar-Sahagun
  • Leonardo Rangel-Castilla
Original Paper

Abstract

Objective

The purpose of this study was to evaluate the efficacy of traditional treatment and minimal invasive flexible endoscopy surgery (MIFNES) in the treatment of intraventricular and subarachnoid basal cisterns neurocysticercosis (NCC).

Methods

This was an observational comparative study of two independent series with a total of 140 patients with extremely severe forms of NCC from two different institutions. All 83 patients submitted for traditional treatment series received albendazole, and some of them received additionally praziquantel. Each cycle of both regimens lasted 4 weeks. The majority of these patients had at least one ventriculoperitoneal (VP) shunt. The rest 57 patients were submitted to the MIFNES treatment. The follow-up period was at least 6 months.

Results

In all patients of both series cysticercal cysts disappeared, became calcified, or were removed. Symptoms of 136 patients improved. Four patients died. The average in the quality of life measured using the Karnofsky scale improved from a mean of 52.22 and 52.44 at the beginning to 85.48 and 90.37 at 6 months (p < 0.003), in the traditional treatment and MIFNES series, respectively. From traditional treatment, almost all patients remained with at least one VP shunt, and from the MIFNES series only 12 patients.

Conclusions

The authors postulate that MIFNES is a good alternative for the management of intraventricular and subarachnoid basal cisterns NCC because it allows removal of most of the parasites, rapid recovery of the patients, and removal and placement of shunt under direct vision when necessary. Traditional treatment is a second option where the MIFNES procedure is not available.

Keywords

Neurocysticercosis Intraventricular Subarachnoid Albendazole Neuroendoscopy Endoscopic third ventriculostomy 

References

  1. 1.
    Agapejev S, Da Silva MD, Ueda AK (1996) Severe forms of neurocysticercosis: treatment with albendazole. Arq Neuropsiquiatr 54:82–93PubMedGoogle Scholar
  2. 2.
    Allcut DA, Coulthard A (1991) Neurocysticercosis: regression of a fourth ventricular cyst with praziquantel. J Neurol Neurosurg Psychiatry 54:461–462PubMedCrossRefGoogle Scholar
  3. 3.
    Anandh B, Mohanty A, Sampath S, Praharaj SS, Kolluri S (2001) Endoscopic approach to intraventricular cysticercal lesions. Minim Invasive Neurosurg 44:194–196PubMedCrossRefGoogle Scholar
  4. 4.
    Bergsneider M (1999) Endoscopic removal of cysticercal cysts within the fourth ventricle. Technical note. J Neurosurg 91:340–345PubMedCrossRefGoogle Scholar
  5. 5.
    Bergsneider M, Holly LT, Lee JH, King WA, Frazee JG (2000) Endoscopic management of cysticercal cysts within the lateral and third ventricles. J Neurosurg 92:14–23PubMedCrossRefGoogle Scholar
  6. 6.
    Citow JS, Johnson JP, McBride DQ, Ammirati M (2002) Imaging features and surgery-related outcomes in intraventricular neurocysticercosis. Neurosurg Focus 12:e6PubMedCrossRefGoogle Scholar
  7. 7.
    Colli BO, Martelli N, Assirati JA Jr, Machado HR, de Vergueiro FS (1986) Results of surgical treatment of neurocysticercosis in 69 cases. J Neurosurg 65:309–315PubMedCrossRefGoogle Scholar
  8. 8.
    Colli BO, Martelli N, Assirati Junior JA, Machado HR, Salvarani CP, Sassoli VP, Forjaz SV (1994) Cysticercosis of the central nervous system. I. Surgical treatment of cerebral cysticercosis: a 23 years experience in the Hospital das Clinicas of Ribeirao Preto Medical School. Arq Neuropsiquiatr 52:166–186PubMedGoogle Scholar
  9. 9.
    Cudlip SA, Wilkins PR, Marsh HT (1998) Endoscopic removal of a third ventricular cysticercal cyst. Br J Neurosurg 12:452–454PubMedCrossRefGoogle Scholar
  10. 10.
    Cuetter AC, Andrews RJ (2002) Intraventricular neurocysticercosis: 18 consecutive patients and review of the literature. Neurosurg Focus 12:e5PubMedCrossRefGoogle Scholar
  11. 11.
    DeFeo D, Foltz EL, Hamilton AE (1975) Double compartment hydrocephalus in a patient with cysticercosis meningitis. Surg Neurol 4:247–251PubMedGoogle Scholar
  12. 12.
    DeFeo D, Foltz EL, Hamilton AE (1975) Double compartment hydrocephalus in a patient with cysticercosis meningitis. Surg Neurol 4:247–251PubMedGoogle Scholar
  13. 13.
    Del Brutto OH, Sotelo J, Aguirre R, Diaz-Calderon E, Alarcon TA (1992) Albendazole therapy for giant subarachnoid cysticerci. Arch Neurol 49:535–538PubMedGoogle Scholar
  14. 14.
    Estanol B, Corona T, Abad P (1986) A prognostic classification of cerebral cysticercosis: therapeutic implications. J Neurol Neurosurg Psychiatry 49:1131–1134PubMedCrossRefGoogle Scholar
  15. 15.
    Gravori T, Steineke T, Bergsneider M (2002) Endoscopic removal of cisternal neurocysticercal cysts. Technical note. Neurosurg Focus 12:e7PubMedCrossRefGoogle Scholar
  16. 16.
    Grieco A, Long CJ (1984) Investigation of the Karnofsky performance status as a measure of quality of life. Health Psychol 3:129–142PubMedCrossRefGoogle Scholar
  17. 17.
    Husain M, Jha DK, Rastogi M, Husain N, Gupta RK (2007) Neuro-endoscopic management of intraventricular neurocysticercosis (NCC). Acta Neurochir (Wien) 149:341–346CrossRefGoogle Scholar
  18. 18.
    Joubert J, van As AD (1990) Rapid and complete resolution of giant cysticercal cysts after administration of praziquantel. A report of 4 cases. S Afr Med J 77:154–157PubMedGoogle Scholar
  19. 19.
    Kelley R, Duong DH, Locke GE (2002) Characteristics of ventricular shunt malfunctions among patients with neurocysticercosis. Neurosurgery 50:757–761PubMedCrossRefGoogle Scholar
  20. 20.
    Madrazo I, Garcia-Renteria JA, Sandoval M, Lopez Vega FJ (1983) Intraventricular cysticercosis. Neurosurgery 12:148–152PubMedCrossRefGoogle Scholar
  21. 21.
    Nash TE, Singh G, White AC, Rajshekhar V, Loeb JA, Proano JV, Takayanagui OM, Gonzalez AE, Butman JA, DeGiorgio C, Del Brutto OH, Delgado-Escueta A, Evans CA, Gilman RH, Martinez SM, Medina MT, Pretell EJ, Teale J, Garcia HH (2006) Treatment of neurocysticercosis: current status and future research needs. Neurology 67:1120–1127PubMedCrossRefGoogle Scholar
  22. 22.
    Nash TE, Singh G, White AC, Rajshekhar V, Loeb JA, Proano JV, Takayanagui OM, Gonzalez AE, Butman JA, DeGiorgio C, Del Brutto OH, Delgado-Escueta A, Evans CA, Gilman RH, Martinez SM, Medina MT, Pretell EJ, Teale J, Garcia HH (2006) Treatment of neurocysticercosis: current status and future research needs. Neurology 67:1120–1127PubMedCrossRefGoogle Scholar
  23. 23.
    Prasad S, MacGregor RR, Tebas P, Rodriguez LB, Bustos JA, White AC Jr (2006) Management of potential neurocysticercosis in patients with HIV infection. Clin Infect Dis 42:e30–e34PubMedCrossRefGoogle Scholar
  24. 24.
    Proano JV, Madrazo I, Garcia L, Garcia-Torres E, Correa D (1997) Albendazole and praziquantel treatment in neurocysticercosis of the fourth ventricle. J Neurosurg 87:29–33PubMedCrossRefGoogle Scholar
  25. 25.
    Proano JV, Madrazo I, Avelar F, Lopez-Felix B, Diaz G, Grijalva I (2001) Medical treatment for neurocysticercosis characterized by giant subarachnoid cysts. N Engl J Med 345:879–885PubMedCrossRefGoogle Scholar
  26. 26.
    Psarros T, Zouros A, Coimbra C (2003) Bromocriptine-responsive akinetic mutism following endoscopy for ventricular neurocysticercosis. Case report and review of the literature. J Neurosurg 99:397–401PubMedCrossRefGoogle Scholar
  27. 27.
    Psarros TG, Krumerman J, Coimbra C (2003) Endoscopic management of supratentorial ventricular neurocysticercosis: case series and review of the literature. Minim Invasive Neurosurg 46:331–334PubMedCrossRefGoogle Scholar
  28. 28.
    Rangel-Castilla L, Serpa JA, Gopinath SP, Graviss EA, az-Marchan P, White AC Jr (2009) Contemporary neurosurgical approaches to neurocysticercosis. Am J Trop Med Hyg 80:373–378PubMedGoogle Scholar
  29. 29.
    Schroeder HW, Oertel J, Gaab MR (2004) Endoscopic aqueductoplasty in the treatment of aqueductal stenosis. Childs Nerv Syst 20:821–827PubMedCrossRefGoogle Scholar
  30. 30.
    Schultz TS, Ascherl GF Jr (1978) Cerebral cysticercosis: occurrence in the immigrant population. Neurosurgery 3:164–169PubMedCrossRefGoogle Scholar
  31. 31.
    Shandera WX, Kass JS (2006) Neurocysticercosis: current knowledge and advances. Curr Neurol Neurosci Rep 6:453–459PubMedCrossRefGoogle Scholar
  32. 32.
    Shandera WX, White AC Jr, Chen JC, Diaz P, Armstrong R (1994) Neurocysticercosis in Houston, Texas. A report of 112 cases. Medicine (Baltimore) 73:37–52Google Scholar
  33. 33.
    Soto Hernandez JL, Ostrosky ZL, Tavera G, Gomez AA (1996) Neurocysticercosis and HIV infection: report of two cases and review. Surg Neurol 45:57–61PubMedCrossRefGoogle Scholar
  34. 34.
    Stern WE (1981) Neurosurgical considerations of cysticercosis of the central nervous system. J Neurosurg 55:382–389PubMedCrossRefGoogle Scholar
  35. 35.
    Torres-Corzo J, Vecchia RR, Rangel-Castilla L (2005) Observation of the ventricular system and subarachnoid space in the skull base by flexible neuroendoscopy: normal structures. Gac Med Mex 141:165–168PubMedGoogle Scholar
  36. 36.
    Torres-Corzo J, Rodriguez-della VR, Rangel-Castilla L (2006) Bruns syndrome caused by intraventricular neurocysticercosis treated using flexible endoscopy. J Neurosurg 104:746–748PubMedCrossRefGoogle Scholar
  37. 37.
    Zymberg ST, Paiva Neto MA, Gorgulho AA, Cavalheiro S (2003) Endoscopic approach to fourth ventricle cysticercosis. Arq Neuropsiquiatr 61:204–207PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Jefferson V. Proaño
    • 1
  • Jaime Torres-Corzo
    • 2
  • Roberto Rodríguez-Della Vecchia
    • 2
  • Gabriel Guizar-Sahagun
    • 1
  • Leonardo Rangel-Castilla
    • 2
    • 3
    • 4
  1. 1.Medical Research Unit for Neurological Diseases, Hospital de Especialidades, Centro Medico Nacional Siglo XXIMexican Institute of Social SecurityMéxicoMéxico
  2. 2.Neuro Endoscopy Clinic, Department of NeurosurgeryInstituto Potosino de Neurociencias A. C. and Medical School of San Luis Potosí (SLP)San Luis PotosíMexico
  3. 3.Division of NeurosurgeryUniversity of Texas Medical Branch (UTMB)GalvestonUSA
  4. 4.Department of NeurosurgeryThe Methodist Neurological Institute, The Methodist Hospital SystemHoustonUSA

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