Surgical management of neurocysticercosis

Abstract

Neurocysticercosis (NCC) is caused by the larval form of the pork tapeworm Taenia solium and is the commonest parasitic infestation of the central nervous system. NCC is usually managed medically but in some instances surgery is required. Magnetic resonance imaging (MRI) and computed tomography (CT) are often able to provide the diagnosis of NCC in most patients with intraventricular and parenchymal cysts but in patients with hydrocephalus without any cysts, the diagnosis is confirmed by the presence of cysticercal antibodies in the serum. Surgery is usually recommended for intraventricular cysts, hydrocephalus, large cisternal cysts, large parenchymal cysts and when the diagnosis is not certain on imaging studies. For intraventricular cysts, endoscopic surgery is the procedure of choice as it is minimally invasive. For incompletely excised cysts and cysts or granulomas in locations such as the spinal cord, medical treatment with steroids and albendazole is recommended. Hydrocephalus is treated with a ventriculo-peritoneal shunt but shunts in these patients suffer from frequent obstructions and require multiple revisions. The outcome for patients with intraventricular and parenchymal cysts is usually good but for those with hydrocephalus associated with cisternal or racemose cysts and with cysticercotic meningitis, the mortality is high.