Surgical Treatment of Cysticercosis of the Central Nervous System

Abstract

Summary: Cysticercosis is the most frequent parasitosis of the central nervous system. Because anticysticercal drugs do not prevent complications such as hydrocephalus, many patients with cysticercosis require surgical intervention. A review of the pathophysiology and surgical treatment of this disease is presented. Free spinal cysts may need surgical removal, generally with transient good results. Cysts compressing cranial nerves or the brainstem may be removed, generally with good results. Frequently patients with cysticercosis need surgery to control increased intracranial pressure. Based on the pathophysiological mechanisms of intracranial hypertension, different surgical approaches may be indicated. Giant cysts are removed with good results. Patients with the pseudotumoral form of cyst whose clinical treatment has failed generally have poor outcomes when subjected to decompressive craniectomies. Removal of cysts and/or ventriculoperitoneal shunting are performed in patients with hydrocephalus. Removal of free ventricular cysts generally produces a good outcome. Patients with adherent cysts need ventriculoperitoneal shunting posteriorly. Patients with inflammatory hydrocephalus require ventriculoperitoneal shunting. Despite many complications, ventriculoperitoneal shunting is effective to control increased intracranial pressure. Generally, patients with intraparenchymal forms of cysticercosis (normal size or giant cysts) have a better prognosis than do patients with the extraparenchymal form (cisternal, ventricular, and spinal), except for cases of free intraventricular cysts. We present our recent policy for management of patients with this disease.