The Surgical Value of Neurocysticercosis: Analyzing 10 Patients in 5 Years

choice. However, the data regarding the surgical management of NCC is quite insufficient, especially for extraparenchymal NCC. Many scholars advocate that anti-parasitic therapy should be considered as a priority in parenchymal NCC and steroids and anti-epileptic drugs are also chosen commonly in case of brain edema and seizures caused by the cysticerci (2,5,10). In contrast, extraparenchymal NCC is often associated with more severe complications such as hydrocephalus, arachnoiditis and ventriculitis. Yet, there is still no clear consensus on its treatment in the literature (9,10). The █ INTRODUCTION Neurocysticercosis (NCC) is a common intracranial parasitic disease in developing countries, with a predilection for the brain parenchyma, subarachnoid space and ventricles. Due to its different locations, numbers, and developmental stages, the intracranial complications and clinical manifestations vary from person to person. The standardized treatment of NCC is still controversial (10). So far, the medical treatment of cysticercosis in the central nervous system is the primary AIm: To investigate the indications and clinical value of the surgical therapy of neurocysticercosis (NCC). mATERIAl and mEThODS: We retrospectively reviewed all 10 patients with NCC treated surgically from January 2009 to January 2014 in our institute. The NCC types included parenchymal cysticerci in 6 cases, subarachnoid cysticerci in 3 and ventricular cysticerci in 1. RESUlTS: All 10 patients underwent resection of cysticerci through craniotomy. Parenchymal NCC included an isolated lesion in 4 cases and multi-lesions in 2 cases, who respectively had coexistence of metastasis and cysticerci and a positive history of tuberculosis. In all 3 patients with arachnoid NCC, two cases underwent lesion resection and the other one underwent cyst resection and lamina terminalis fenestration. In one case with intraventricular NCC, a ventriculoperitoneal (VP) shunt was placed as the initial treatment. Due to failure of the shunt, the secondary surgery of cyst excision via open craniotomy and VP shunt placement were performed simultaneously. CONClUSION: For parenchymal cysticercosis, the surgical aim is to remove the lesion, treat the medically intractable epilepsy, and establish the diagnosis and subsequent treatment. As for extraparenchymal NCC, surgical therapy is a valuable treatment as an alternative due to its fatal complications. For subarachnoid cysticercosis, because of its higher failure rate in simply VP shunt, the open craniotomy could directly remove the cyst and efficaciously relieve hydrocephalus. For the patient with intraventricular NCC associated with hydrocephalus, the effect of a simple VP shunt seems unsatisfactory, and craniotomy for cyst resection is necessary. KEywORDS: Neurosurgery, Cysticercosis, Central nervous system