Endoscopic management of hydrocephalus due to neurocysticercosis.
OBJECTIVE
Hydrocephalus due to neurocysticercosis usually shows poor prognosis and shunt failure is a common complication. Neuroendoscopy has been suggested as treatment, but the indications remain unclear.


METHODS
A cohort of patients with clinical/radiological diagnosis of hydrocephalus due to NCC, treated between January 2002 and September 2006, were the subjects of the study. We excluded patients with tumors or those in whom diagnosis was not confirmed (histology/positive ELISA in CSF). Neuroendoscopy was offered as the first line of treatment. Shunt failure rate and Karnofsky index at 12 months were assessed.


RESULTS
Eighty-six patients (47 male) with a median age of 38 (9-79) were included in the study. Of them, 36.1% had a shunt before endoscopy and 97.7% had a Karnofsky index <80. We did not find the parasite in 18.6%, extraction was achieved in 79%, and in 87.2% an endoscopic third ventriculostomy (ETV) was performed. The median follow-up time was 43 months (1-72). Shunt failure was seen in 6.6% of patients with ETV in comparison to 27.2% in those without ETV. A hazard ratio of 0.22 (95% CI, 0.05-0.93) for shunt failure after ETV was calculated. At 12 months, 20.9% had a Karnofsky index <80.


CONCLUSIONS
Early extraction of parasite plus ETV might allow improving outcome and reducing shunt failure. Limitation of inflammatory stimulation by parasite antigens and improvement of CSF dynamics could be an explanation for these findings.
Torres-Corzo
Jaime G
JG
Neurosurgery Deparment, Hospital Central "Dr. Ignacio Morones Prieto, Mexico. torrescjaime@yahoo.com.mx
Tapia-Pérez
J Humberto
JH
Vecchia
Roberto Rodriguez-Della
RR
Chalita-Williams
Juan C
JC
Sánchez-Aguilar
Martín
M
Sánchez-Rodríguez
José Juan
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000768:Anesthesia, General; D002535:Cerebral Aqueduct / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D018450:Disease Progression; D004724:Endoscopy; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000601:surgery*; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020019:Neurocysticercosis / Q000134:cerebrospinal fluid / Q000150:complications* / Q000469:parasitology; D044583:Neuroendoscopy; D019635:Neurosurgical Procedures; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D014696:Ventriculostomy; D055815:Young Adult