Surgical treatment of neurocysticercosis. Retrospective cohort study and an illustrative case report
Keywords:
Neurocysticercosis, Hydrocephalus, Epilepsy, Ventriculoperitoneal shunt, Central nervous system infections, Neurosurgical procedures, Case reports, Cohort studiesAbstract
CONTEXT AND OBJECTIVE: Neurocysticercosis is prevalent in developing countries and manifests with several neurological signs and symptoms that may be fatal. The cysts may be parenchymal or extraparenchymal and therefore several signs and symptoms may occur. Depending on their location, neurosurgical procedures may be required, sometimes as emergencies. The aim here was to review 10-year statistics on all surgical neurocysticercosis cases at a large public tertiary-level hospital. DESIGN AND SETTING: Retrospective cohort at a large public tertiary-level hospital. METHODS: All surgical neurocysticercosis cases seen between July 2006 and July 2016 were reviewed. Parenchymal and extraparenchymal forms were considered, along with every type of surgical procedure (shunt, endoscopic third ventriculostomy and craniotomy). The literature was reviewed through PubMed, using the terms “neurocysticercosis”, “surgery”, “shunt” and “hydrocephalus”. RESULTS: 37 patients underwent neurosurgical procedures during the study period. Most were male (62.16%) and extraparenchymal cases predominated (81%). Patients aged 41 to 50 years were most affected (35.13%) and those 20 years or under were unaffected. Ventricular forms were most frequently associated with hydrocephalus and required permanent shunts in most cases (56.57%). CONCLUSIONS: The treatment of neurocysticercosis depends on the impairment: the parenchymal type usually does not require surgery, which is more common in the extraparenchymal form. Hydrocephalus is a frequent complication because the cysts often obstruct the cerebrospinal flow. The cysts should be removed whenever possible, to avoid the need for permanent shunts.
Downloads
References
Rangel-Castilla L, Serpa JA, Gopinath SP, et al. Contemporary neurosurgical approaches to neurocysticercosis. Am J Trop Med Hyg. 2009;80(3):373-8.
John CC, Carabin H, Montano SM, et al. Global research priorities for infections that affects the nervous system. Nature. 2015;527(7578): S178-86.
Paiva ALC, de Aguiar GB, Haddad de Souza A, Veiga JCE, de A. Silva JM. Forma tumoral de la neurocisticercosis. Medicina (B. Aires). 2015;75(2):103-103.
Gonzales I, Garcia HH. Current status and future perspectives on the medical treatment of neurocysticercosis. Pathog Glob Health. 2012;106(5):305-9.
O'Neal SE, Flecker RH. Hospitalization frequency and charges for neurocysticercosis, United States, 2003-2012. Emerg Infect Dis. 2015;21(6):969-76.
Bruno E, Bartoloni A, Zammarchi L, et al. Epilepsy and neurocysticercosis in Latin America: a systematic review and meta-analysis. PLoS Negl Trop Dis. 2013;7(10):e2480.
Henneberg R. Die tierischen Parasiten des Zentralnervensystems. In: Lewandowsky M, editor. Handbuch der Neurologie. Berlin: Verlag Von Julius Springer; 1912. p. 643-712.
Garcia HH, Gonzalez AE, Gilman RH. Cysticercosis of the central nervous system: how should it be managed? Curr Opin Infect Dis. 2011;24(5):423-7.
Colli BO, Carlotti CG Jr, Assirati JA Jr, et al. Surgical treatment of cerebral cysticercosis: long-term results and prognostic factors. Neurosurg Focus. 2002;12(6):e3.
Fleury A, Carrillo-Mezo R, Flisser A, Sciutto E, Corona T. Subarachnoid basal neurocysticercosis: a focus on the most severe form of the disease. Expert Rev Anti Infect Ther. 2011;9(1):123-33.
Estañol B, Corona T, Abad P. A prognostic classification of cerebral cysticercosis: therapeutic implications. J Neurol Neurosurg Psychiatry. 1986;49(10):1131-4.
