Surgical treatment of cerebral cysticercosis: long-term results and prognostic factors.
OBJECTIVE
Cysticercosis is the most frequent parasitosis of the central nervous system. Although anticysticercal drugs have proven efficient in some cases, many patients with NCC require palliative, occasionally curative, surgical procedures. The authors analyzed the data and prognostic factors obtained during the follow-up period (range 1-255 months, median 38 months) in 160 patients with cerebral cysticercosis who underwent surgical treatment.


METHODS
Different surgical approaches were indicated to control increased intracranial pressure (ICP) in most patients, and some patients had undergone decompressive surgery for local brain lesions. Most patients required more than one surgical procedure. Statistical analysis was performed using the Fisher exact, the log-rank, and the Kruskall-Wallis tests. Survival curves were calculated according the Kaplan-Meier method. The removal of a giant cyst from the parenchyma or cisterns for relief of increased ICP and for chiasm/optic nerve decompression improved most symptoms in patients. The removal of ventricular cysts was effective in the control of increased ICP in most patients. Patients with a ventricular cyst and ependymitis/arachnoiditis required placement of a ventriculoperitoneal (VP) shunt after the cyst was removed. This therapy effectively controlled increased ICP. Patients younger than 40 years of age at the time of treatment and male patients had worse outcomes. The outcome in patients who underwent VP shunt surgery or shunt surgery combined with reservoir implantation was worse than that in those who underwent cyst removal alone. Shunt-related infection was the most frequent complication, and the global mortality rate during the follow-up period was 21.2%. Although both complications were more frequent in the first 2 postoperative years, they occurred at any time.


CONCLUSIONS
Long-term prognosis in patients with cerebral cysticercosis who required surgery was not good. Cysts located in the basal cisterns and patient age younger than 40 years were poor prognostic factors.
Colli
Benedicto O
BO
Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. bocolli@fmrp.usp.br
Carlotti
Carlos G
CG
Assirati
João A
JA
Machado
Hélio R
HR
Valença
Marcelo
M
Amato
Marcelo C M
MC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000871:Anthelmintics / Q000627:therapeutic use; D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000469:parasitology / Q000601:surgery; D019586:Intracranial Hypertension / Q000469:parasitology / Q000601:surgery; D007427:Intracranial Pressure; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009026:Mortality; D020019:Neurocysticercosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt
D000871:Anthelmintics