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.

Key words

Cysticercal Cyst - Endoscopy/ic - Intraventricular

References

• 1 Allcut D A. Neurocysticercosis: Regression of a fourth ventricular cyst with praziquantel.  J Neurol Neurosurg Psychiatry. 1991;  54 461-462
• 2 Apuzzo M LJ, Dobkin W R, Zee C S, Chan J C, Giannotta S L, Weiss M H. Surgical considerations in treatment of intraventricular cysticercosis. An analysis of 45 cases.  J Neurosurg. 1984;  60 400-407
• 3 Cuetter A C, Garcia B J, Guerra L G, Martinez F M, Kaim B. Neurocysticercosis: Focus on intraventricular disease.  Clin Infect Dis. 1997;  24 157-164
• 4 del Brutto O H, Sotelo J. Albendozole therapy for subarachnoid and ventricular cysticercosis. Case report.  J Neurosurg. 1990;  72 816-817
• 5 Fandiño J, Botana C, Fandiño C, Rodriguez D, Gomez-Bueno J. Clinical and radiographic response of IV ventricle cysticercosis to praziquantel therapy.  Acta Neurochir (Wien). 1991;  111 135-137
• 6 Garg R K. Drug treatment of neurocysticercosis.  Natl Med J India. 1997;  10 173-177
• 7 Hopf N J, Perneczky A. Endoscopic neurosurgery and endoscopeassisted microneurosurgery for the treatment of intracranial cysts.  Neurosurgery. 1998;  43 1330-1337
• 8 Kushwaha R, Verma A, Patir R, Mehta V S. Neuroendoscopy in AIIMS.  Neurology India (abstract). 1997;  45 45
• 9 Martinez H R, Rangel-Guerra R, Arredondo-Estrada H J, Marfil A, Onofre J. Medical and surgical treatment in neurocysticercosis a magnetic resonance study of 161 cases.  J Neurol Sci. 1995;  130 25-34
• 10 Neal J H. An endoscopic approach to cysticercosis cysts of the posterior III ventricle.  Neurosurgery. 1995;  36 1040-1043
• 11 Proaño J V, Madrazo I, Gracia L, Garcia-Torres E, Correa D. Albandozole and Praziquantel treatment in neurocysticercosis of the fourth ventricle.  J Neurosurg. 1997;  87 29-33
• 12 Sandoval M, Madrazo I, Gracia-Renteria J A, Maldonando J A, Lopez-Camacho O. Obstruction of ventricular catheter of CSF shunt system due to the own cyst of Taenia Solium.  Arch Invest Med (mex) (abstr). 1990;  21 95-98
• 13 Sandoval M, Madrazo I, Gracia-Renteria J A, Maldonando J A, Lopez-Camacho O. Valvular dysfunction due to obstruction of the ventricular catheter caused by the cysticercus cyst.  Arch Invest Med (Mex) (abstr). 1991;  22 117-120