Endoscopic Management of Supratentorial Ventricular Neurocysticercosis: Case Series and Review of the Literature

Abstract

Objective: Despite the increasing popularity of neuroendoscopy, scarce documentation exists in the literature regarding successes and failures of this treatment modality for ventricular cysticercosis. Since July 2000, we instituted a specific endoscopic strategy for select patients with supratentorial ventricular disease. The goals of the strategy were to 1) remove ventricular cysts; 2) employ internal CSF diversion procedures for hydrocephalus to avoid shunting, and; 3) elude open surgical procedures.

Methods: A retrospective analysis of the charts of 7 patients managed with an endoscope for symptomatic hydrocephalus and supratentorial ventricular cysts was performed. A description of our management plan is given.

Results: From July 2000 through July 2002, we successfully resected all supratentorial ventricular cysts in 7 patients with an endoscope and employed three septostomies and four third ventriculostomies in the same sitting. None of the seven patients required shunting or further surgery to date. No case of postoperative ventriculitis occurred despite an 86 % cyst rupture rate. One cyst adjacent to the left foramen of Monro, which was successfully resected, produced significant intraventricular bleeding during surgical dissection. This patient developed akinetic mutism postoperatively, which improved with bromocriptine. The follow-up period was 16 months (range, 10 - 24 months).

Conclusions: The ease of performing septostomies and third ventriculostomies in conjunction with cyst removal makes these procedures appealing and practical for most cases of ventricular cysticercosis.

Key words

Neurocysticercosis - endoscopy - ventriculocisternostomy - shunt

References

• 1 Anandh B, Mohanty A, Sampath S, Praharaj S S, Kolluri S. Endoscopic approach to intraventricular cysticercal lesions.  Minim Invas Neurosurg. 2001;  44 194-196
• 2 Bandres J C, White A C, Samo T. Extraparenchymal neurocysticercosis; report of five cases and review of management.  Clinical Infectious Disease. 1992;  15 799-811
• 3 Bergsneider M, Holly L T, Lee J H, King W A, Frazee J G. Endoscopic management of cysticercal cysts within the lateral and third ventricles.  J Neurosurg. 2000;  92 14-23
• 4 Bergsneider M. Endoscopic removal of cysticercal cysts within the fourth ventricle.  J Neurosurg. 1999;  91 340-345
• 5 Buxton N, Punt J. Cerebral infarction after neuroendoscopic third ventriculostomy: case report. Neurosurgery 2001 48: 452-454
• 6 Collie B O, Martelli N, Assirati Jr J A. Results of surgical treatment of neurocysticercosis in 69 cases.  J Neurosurg. 1986;  65 309-315
• 7 Cudlip S A, Wilkins P R, Marsh H T. Endoscopic removal of a third ventricular cysticercal cyst.  British J Neurosurg. 1998;  12 452-454
• 8 Duma D, Argintaru D, Serban M. Mesodiencephalic tumors with akinetic mutism.  Neurol Psihiatr Neurochir. 1967;  12 673
• 9 Echiverri H, Tatuni W, Merens T, Coker S. Akinetic mutism: Pharmacologic probe of the dopaminergic mesencephalofrontal activating system.  Pediatric Neurology. 1988;  4 228-230
• 10 Kadota Y, Kondo T, Sato K. Akinetic mutism and involuntary movements following radical resection of hypothalamic glioma - case report.  Neurol Med Chir (Tokyo). 1996;  36 447-450
• 11 LeBlanc R, Knowles K F, Melanson D. Neurocysticercosis: surgical and medical management with Praziquantel.  Neurosurgery. 1986;  18 419-427
• 12 Madrazo I, Garcia-Renteria J A, Sandoval M. et al . Intraventricular cysticercosis.  Neurosurgery. 1983;  12 148-152
• 13 Madrazo I, Cabrera Sanchez J, Maldanado A. Pipette suction for atraumatic extraction of intraventricular cysticercosis cysts.  J Neurosurg. 1979;  50 531-532
• 14 McCormick G F. Cysticercosis - review of 230 patients.  Bulletin of Clinical Neuroscience. 1985;  50 76-101
• 15 Moolten S. Syndrome of profound apathy (akinetic mutism) secondary to thalamic metastasis of unrecognized lung cancer.  Mount Sinai J Medicine. 1972;  39 76-81
• 16 Nemeth G, Hegedus K, Molnar L. Akinetic mutism associated with bicingular lesions: clinicopathalogical and functional anatomical correlates.  European Archives of Psychiatry Neurological Sciences. 1988;  237 218-222
• 17 Oberndorfer S, Urbanits S, Lahrmann H, Kirschner H, Kumpan W. Akinetic mutism caused by bilateral infiltration of the fornix in a patient with astrocytoma.  Eur Journal Neurol. 2002;  9 311-313
• 18 Obrader S. Cysticercosis Cerebri.  Acta Neurochir. 1962;  10 320-364
• 19 Proano J V, Madrazo I, Garcia L. Albendazole and Praziquantal treatment in neurocysticercosis of the fourth ventricle.  J Neurosurg. 1997;  87 29-33
• 20 Psarros T, Zouros A, Coimbra C. Bromocriptine-responsive akinetic mutism following endoscopy for ventricular neurocysticercosis: Case report and review of the literature.  J Neurosurgery. 2003;  99 397-401
• 21 Psarros T, Zouros A, Coimbra C. Neurocysticercosis: A neurosurgical perspective.  Southern Medical Journal. 2003;  96 (10) 1019-1022
• 22 Sainte-Rose C, Hoffman H J, Hirsch J F. Shunt failure.  Concepts of Pediatric Neurosurg. 1989;  9 20
• 23 Skultety F M. Clinical and experimental aspects of akinetic mutism.  Arch Neur. 1968;  19 1-16
• 24 Sotelo J, Marin C. Hydrocephalus secondary to cysticercotic arachnoiditis: a long term follow-up review of 92 cases.  J Neurosurg. 1987;  66 686-689
• 25 Domburg P van, Donkelaar H, Notermans S. Akinetic mutism with bithalamic infarction. Neurophysiological correlates.  J Neurolog Sciences. 1996;  139 58-65
• 26 Watahiki Y, Narita S, Kurahashi K. (Akinetic mutism from recurrent hydrocephalus: successful treatment with levadopa, bromocriptine, and trihexyphenidyl.)  No To Shinki (Jpn). 1987;  39 977-982
• 27 Wei G Z, L C J, Meng J M. Cysticercosis of the central nervous system. A clinical study of 1400 Cases.  Chin Med Journal. 1988;  101 493-500
• 28 Weparin B E, Swift D M. Complications of ventricular shunts.  Techniques in Neurosurg. 2002;  7 224-242