Stereotactic Endoscopic Removal of Cerebral Cysticercosis

Lee, Jung Ho; Kim, Myung Hyun

Abstract

Cysticercosis is the most frequent parasitosis of the central nervous system. A considerable group of patients require surgical procedures, especially in cases of neural compression, intracranial hypertension, or epilepsy. Recently stereotactic endoscopic removal of small intraaxial lesions using a stereotactic guiding tube and a fine endoscope was reported. We tried to control the symptomatic neurocysticercosis using the stereotactic endoscopic system. Since the introduction of this styem, we had operated on 4 cases of neurocysticercosis. Enzyme linked immunoserological assay of cerebrospinal fluid(CSF ELISA), electroencephalogram(EEG), enhanced computerized tomogram(CT) and magnetic resonance image(MRI) were done. The result of CSF ELISA were positive in 3 patients, negative in 1 patients. All patients showed abnormal patterns of preoperative EEG. CT and MRI scans showed single intraparenchymal lesion in 2 cases, multiple intraventricular cysts with obstructive hydrocephalus in 1 case and mixed in 1 case. A ll patients showed seizures;partial sensory type in 3 cases who had reciprocal intraparenchymal lesions, generalized type in 1 case who had dobstructive hydrocephalus by multiple ventricular cysts. For parenchymal lesions, we planned stereotactic open system endoscopic surgery with variable forceps, laser, and suction. Cystic forms were removed successfully but solid forms needed additional transgyral microscopic removal. In intraventricular lesions, we first placed a stereotactic guiding tube via the frontal burr hole, then replaced this with a 14 Fr peel-away catheter. Through the peel-away catheter we inserted closed system endoscopy and removed the cysts with variable forceps and suction. All intraparenchymal and intraventricular lesions were removed without specific complications except one who showed transient chemical meningitis. After 6 months, seizure was improved in all patients:3 patients can stop their medication;1 patient can reduce the dosage of his medication. Stereotactic endoscopic surgery ma kes it possible to operate cystic lesions without degeneration(vesicular stage) wherever they ware located. We believe that it may be the first option for the treatment of intraventricular and intraparenchymal cerebral neurocysticercosis especially in the early stages of degeneration.