Stereotactic surgery for neurocysticercosis of the 4th ventricle: illustrative cases.

Luis J Saavedra,Yelimer Caucha,Luis A Antonio,Hector H García,William W Lines,Carlos M Vásquez,Jorge E Medina,Jesús Félix

doi:10.3171/case21279

Luis J Saavedra, Yelimer Caucha + Show 6 more

Open Access

https://doi.org/10.3171/case21279

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Abstract

BACKGROUNDNeurocysticercosis, caused by the larval stage of Taenia solium, affects the cerebral ventricles in 20–30% of cases and may lead to hydrocephalus and other neurological morbidity. Conventional treatment for cysts in the 4th ventricle includes open surgery (suboccipital approach) and neuroendoscopy, with the latter being the option of choice. Stereotactic surgery, minimally invasive, offers a good alternative for this type of deep lesion.OBSERVATIONSThe authors report the cases of two women, 30 and 45 years old, who presented with headache, dizziness, and ataxia and were diagnosed with 4th ventricle cysticercosis. Magnetic resonance imaging (MRI) revealed dilated 4th ventricles (approximately 2.5 cm in both cases, with cystic images inside the ventricular cavity). Both patients were treated with stereotactic surgery via a suboccipital transcerebellar approach. Cyst material was extracted, and the diagnosis was confirmed by pathological examination. The surgeries had no complications and resulted in clinical improvement. Control MRI scans showed reduction of the volume of the ventricle without residual cysts.LESSONSMinimally invasive stereotactic surgery provided a safe alternative for 4th ventricle neurocysticercosis cysts, with more benefits than risks in comparison with conventional techniques.

Highlights

Neurocysticercosis, caused by the larval stage of Taenia solium, affects the cerebral ventricles in 20–30% of cases and may lead to hydrocephalus and other neurological morbidity
Neurocysticercosis (NCC), a zoonosis caused by the invasion of the human central nervous system by the cystic larval stage of the pork tapeworm (Taenia solium), is the most frequent neurological helminth infection worldwide and one of the most frequent causes of epilepsy and hydrocephalus in adult patients.[1,2,3,4]
At 3 and 24 months, control brain Magnetic resonance imaging (MRI) was performed, which showed that the 4th ventricle had recovered its size and that there were no remnant cystic lesions inside

Summary

BACKGROUND

Neurocysticercosis, caused by the larval stage of Taenia solium, affects the cerebral ventricles in 20–30% of cases and may lead to hydrocephalus and other neurological morbidity. Magnetic resonance imaging (MRI) revealed dilated 4th ventricles (approximately 2.5 cm in both cases, with cystic images inside the ventricular cavity). Both patients were treated with stereotactic surgery via a suboccipital transcerebellar approach. LESSONS Minimally invasive stereotactic surgery provided a safe alternative for 4th ventricle neurocysticercosis cysts, with more benefits than risks in comparison with conventional techniques. Neurocysticercosis (NCC), a zoonosis caused by the invasion of the human central nervous system by the cystic larval stage of the pork tapeworm (Taenia solium), is the most frequent neurological helminth infection worldwide and one of the most frequent causes of epilepsy and hydrocephalus in adult patients.[1,2,3,4] NCC can be parenchymal, ventricular, or subarachnoid.

Illustrative Cases

Anesthesia Local

Discussion