Abstract
Purpose
Subarachnoid cysticercosis, an uncommon form of neurocysticercosis, can occasionally grow to giant size causing mass effect and obstructive hydrocephalus. These often require surgical excision to relieve the mass effect and re-establish the cerebrospinal fluid (CSF) pathways.
Clinical presentation
The authors report a rare case of giant anterior interhemispheric racemose cysticercosis with extension to the region of septum pellucidum causing obstructive hydrocephalus.
Intervention
Due to the proximity of the cysts to the dilated ventricular system, a frontal transventricular endoscopic approach was preferred over a conventional microsurgical or endoscopic-assisted microsurgical approach. Most of the cysts could be successfully resected from the region of septum pellucidum and the anterior interhemisphere. The patient did not require a CSF diversion procedure in the postoperative period.
Conclusion
Depending on the location and nature of the lesion, a transfrontal transventricular endoscopic approach can be successfully utilized to approach lesions in the anterior interhemispheric region.
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References
Anandh B, Mohanty A, Sampath S, Praharaj SS, Kolluri S (2001) Endoscopic approach to intraventricular cysticercal lesions. Minim Invasive Neurosurg 44:194–196
Bannur U, Rajsekhar V (2002) Cisternal cysticercosis: a diagnostic problem, a short report. Neurol India 49:206–208
Bergsneider M, Holly LT, Lee JH, King WA, Frazee JG (2000) Endoscopic management of cysticercal cysts within the lateral and third ventricles. J Neurosurg 92:14–23
Citow JS, Johnson JP, Mcbride DQ, Ammirati M (2002) Imaging features and surgery-related outcomes in intraventricular neurocysticercosis. Neurosurg Focus 12:Article 6
Colli BO, Carlotti CG, Assirati JA, Machado HR, Valenca M, Amato MC (2002) Surgical treatment of cerebral cysticercosis: long-term results and prognostic factors. Neurosurg Focus 12:Article 3
Couldwell WT, Zee CS, Apuzzo MLJ (1991) Definition of the role of contemporary surgical management in cisternal and parenchymatous cysticercosis cerebri. Neurosurgery 28:231–237
DeGiorgio CM, Houston I, Oviedo S, Sorvillo F (2002) Deaths associated with cysticercosis. Neurosurg Focus 12:Article 2
DeGiorgio CM, Sorvillo F, Escueta SP (2005) Neurocysticercosis in the United States: review of an important emerging infection. Neurology 64:1486
Del Brutto OH, Sotelo J, Aguirre R, Diaz-Calderon E, Alarcon TA (1992) Albendazole therapy for giant subarachnoid cysticerci. Arch Neurol 49:535–538
del la Garza Y, Graviss EA, Daver NG, Gambarin KJ, Shandera WX, Schantz PM, White AC Jr (2005) Epidemiology of neurocysticercosis in Houston, Texas. Am J Trop Med Hyg 73:766–770
Estanol B, Corona T, Abad P (1986) A prognostic classification of cerebral cysticercosis: therapeutic implications. J Neurol Neurosurg Psychiatry 49:1131–1134
Gravori T, Steineke T, Bergsneider M (2002) Endoscopic removal of cisternal neurocysticercal cysts. Technical note. Neurosurg Focus 12:Article 7
Hawk MW, Shahlaie K, Kim DK, Thies JH (2005) Neurocysticercosis: a review. Surg Neurol 63:123–132
Martinez HR, Rangel-Guerra R, Elizondo G, Gonzalez J, Todd LE, Ancer J, Prakash SS (1989) MR imaging in neurocysticercosis: a study of 56 cases. Am J Neuroradiol 10:1011–1019
Perneczky A, Fries G (1998) Endoscopic assisted brain surgery: part I—evolution, basic concept and current technique. Neurosurgery 42:219–225
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 345:879–885
Reisch ER, Perneczky A (2005) Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 57:242–255
Seigel RS, Davis LE, Kaplan RJ, Kanter RA (1983) CT-guided aspiration of a cysticercotic thalamic cyst. Bull Clin Neurosci 48:48–60
Sharma P, Satish C, Goyal M (1999) Racemose cysticercosis: novel demonstration of a rare condition. Australas Radiol 43:523–525
Sotelo J, del Brutto OH (2002) Review of neurocysticercosis. Neurosurg Focus 12:Article 1
Stern WE (1981) Neurosurgical considerations of cysticercosis of the central nervous system. J Neurosurg 55:382–389
Suh DC, Chang KH, Han MH, Lee SR, Han MC, Kim CW (1989) Unusual manifestations of neurocysticercosis. Neuroradiology 31:396–402
Takayanagui OM, Odashima NS (2006) Clinical aspects of neurocysticercosis. Parasitol Int 55:S112–S115
Torrealba G, Del Villar S, Tagle P, Arriagada P, Kase CS (1984) Cysticercosis of the central nervous system: clinical and therapeutic considerations. J Neurol Neurosurg Psychiatry 47:784–790
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Angeles, C.F., Vollmer, D. & Mohanty, A. Transventricular neuroendoscopic excision of giant racemose subarachnoid cysticercosis. Childs Nerv Syst 25, 503–508 (2009). https://doi.org/10.1007/s00381-008-0802-6
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DOI: https://doi.org/10.1007/s00381-008-0802-6