Chelsee Shuler
Biology 1610 Lab
Thursdays
Contemporary Neurosurgical Approaches to Neurocysticercosis
Neurocysticercosis (NCC) is a disease of the central nervous system caused by infection
from the ingestion of eggs from the pork tapeworm Taenia solium. The main symptoms in adults
are seizures and hydrocephalus, and it is most commonly found in regions such as Central and
South America, Asia, Africa, and Eastern Europe. This disease is becoming more common in the
United States because of travel and immigration to and from these regions. NCC can show in
many clinical forms which are based on the number of parasites, their location, and the degree of
inflammation. The possible locations of NCC include parenchymal, subarachnoid, and
intraventricular. The objective of this paper is to describe the current surgical treatments of NCC
and their outcomes.
Charts from Ben Taub General Hospital of patients who had been surgically treated with
NCC from August 1997 through December 2005 with complete information were retrospectively
reviewed. Those patients were then classified according to the location of their cysts, and the
surgical procedures performed. The outcomes were later evaluated by clinical and radiographic
follow-up.
Thirty one of the subjects whose charts were reviewed, were eligible for this research. 16
of those subjects were male; all were Hispanic, and their ages ranged from 22 to 69. They
presented with symptoms such as headache, seizures, nausea and vomiting, visual symptoms,
etc. A computed tomography (CT) of the brain was done on all patients, and 27 of them also
received a magnetic resonance imaging (MRI) on admission or shortly after. Hydrocephalus and
edema was then discovered in most of the patients, along with the location of the disease. The
patients received medical therapies and surgery for the treatment of their NCC. Medical therapy
Chelsee Shuler
Biology 1610 Lab
Thursdays
treatments used included steroids, anti-epileptic drugs, and anti-parasitic drugs. The surgical
approaches included ventriculo-peritoneal (VP) shunts, endoscopic resections, and craniotomies.
Those patients who received a VP shunt, a large portion of them experienced shunt malfunction
and later had to undergo a shunt revision. The few that underwent a craniotomy later had to have
a shunt placed due to relapsed hydrocephalus. Those patients who had endoscopic resections
required no further treatments or therapies.
Certain forms of NCC are more severe than others because of the location of the disease.
Subarachnoid and intraventricular NCC tends to be worse than parenchymal NCC; therefore in
those cases surgery is usually required along with medical therapies while with parenchymal
NCC, surgery could probably be avoided with medical therapies. Also, it seems that with
attention to management of hydrocephalus, fatalities among these patients should be avoidable in
most cases. The surgical procedures used to treat these patients all had different outcomes and
many of them experienced complications. In cases where a VP shunt was placed, the shunt
malfunction rate was high in both subarachnoid and intraventricular NCC patients. That makes
the placement of a shunt a less than desirable option because of the need for further surgery to
correct it. The craniotomies that were performed on a few of the patients were often complicated
by the need for a VP shunt later on, which also makes it a less appealing choice because of the
need for more surgery and the possible need for a shunt revision due to the high malfunction rate.
Those that were treated with endoscopic resection recovered well with no further treatment or
therapies; these positive outcomes seem to make this the more appealing option. There are also
many other significant advantages to the endoscopic procedure compared to the other surgical
options available. For example, the flexible endoscope is easy to maneuver through the ventricles
of the brain in a short amount of time unlike the other procedures, which take more time and are
Chelsee Shuler
Biology 1610 Lab
Thursdays
more technically demanding. This procedure also has the ability to alleviate hydrocephalus, and
it does not seem to cause any further complications from rupturing cysts such as, spreading of
the cysts or inflammation.
In summary, many surgical approaches are used to treat NCC and although the
endoscopic resection procedure seemed to have the best outcomes, more studies are needed to
confirm these findings.