Transventricular, transaqueductal scope-in-scope endoscopic excision of fourth ventricular neurocysticercosis: a series of 13 cases and a review.
OBJECTIVE
Neurocysticercosis (NCC) is the most common parasitic infestation of the central nervous system worldwide. In patients presenting with acute hydrocephalus due to intraventricular NCC, surgery is the only option. Still, there is no consensus regarding the optimal surgical strategy, although neuroendoscopic excision is a promising method. However, the literature regarding the use of this modality in fourth ventricular NCC is scarce. The authors describe a series of patients with fourth ventricular NCC treated endoscopically.


METHODS
The clinical records of 13 patients with fourth ventricular NCC who had presented with hydrocephalus were retrospectively analyzed. A fourth ventricular cyst was completely excised in all patients by using a transventricular, transaqueductal "scope-in-scope" endoscopic technique. Twelve endoscopic third ventriculostomies and 1 septostomy had been performed.


RESULTS
Shunt placement was avoided in all patients. There were minimal peri- and postoperative complications. The mean duration of follow-up was 22.3 months (range 3-41 months). All patients had an improved clinical outcome. Follow-up neuroimaging revealed no residual lesion and a decreased ventricle size in all patients.


CONCLUSIONS
The present series of patients with fourth ventricular NCC is the largest in the existing English-language medical literature. Endoscopic fourth ventricular cysticercal cyst excision along with internal cerebrospinal fluid diversion via endoscopic third ventriculostomy is an effective alternative to open microneurosurgical procedures and avoids shunt placement and its related complications.
Suri
Ashish
A
Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. surineuro@hotmail.com
Goel
Rohit Kumar
RK
Ahmad
Faiz Uddin
FU
Vellimana
Ananth Kesav
AK
Sharma
Bhawani Shankar
BS
Mahapatra
Ashok Kumar
AK
D000293:Adolescent; D000328:Adult; D002535:Cerebral Aqueduct / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D020546:Fourth Ventricle / Q000469:parasitology* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020019:Neurocysticercosis / Q000469:parasitology* / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*