Torres-Corzo Jaime, Rodriguez-della Vecchia Roberto, Rangel-Castilla Leonardo
Clinic of Neurosurgery, Department of Neurosurgery, Foundation for Nervous Diseases Study and Treatment, University of San Luis Potosi Medical School, Potosi, Mexico.
J Neurosurg. 2006 May;104(5):746-8. doi: 10.3171/jns.2006.104.5.746.
Neurocysticercosis is the most frequent cause of hydrocephalus in adults in regions where the disease is endemic, including Latin America. The prognosis for intraventricular neurocysticercosis is worse than that for the intraparenchymal form of the disease, making treatment especially important. Although active and viable intraventricular cysts produce no reaction in the host, they can cause noncommunicating hydrocephalus, whose onset is frequently abrupt. Sometimes the increasing intracranial pressure due to obstruction of the cerebral aqueduct (ball-valve mechanism) is intermittent, producing relapsing/remitting symptoms; this life-threatening phenomenon is called "Bruns syndrome."
Between 1996 and 2004, among a group of 285 patients with neurocysticercosis and Bruns syndrome caused by cysticercal cysts of the third ventricle was diagnosed in seven patients by using magnetic resonance imaging. An endoscopic procedure with a flexible cerebral endoscope was performed, intact parasitic cysts were removed, and a complete exploration was undertaken to look for more cysticercal cysts in the whole ventricular system and the subarachnoid basal cisterns. There were no deaths or complications. All seven patients were asymptomatic during a follow-up period ranging from 1 to 5 years.
Flexible cerebral endoscopy allows one, in a minimally invasive manner, to approach the ventricular system and subarachnoid basal cisterns and to remove intraventricular neurocysticercal cysts. Flexible endoscopy is an alternative treatment for Bruns syndrome caused by neurocysticercosis of the third ventricle.
在包括拉丁美洲在内的囊尾蚴病流行地区，神经囊尾蚴病是成人脑积水最常见的病因。脑室内神经囊尾蚴病的预后比脑实质型该病的预后更差，因此治疗尤为重要。尽管活跃且存活的脑室内囊肿在宿主体内不产生反应，但它们可导致非交通性脑积水，其起病常常突然。有时，由于中脑导水管阻塞（球阀机制）导致的颅内压升高是间歇性的，产生复发/缓解症状；这种危及生命的现象称为“布伦斯综合征”。
1996年至2004年间，在一组285例神经囊尾蚴病患者中，通过磁共振成像诊断出7例由第三脑室囊尾蚴囊肿引起的布伦斯综合征。采用软性脑内窥镜进行了内窥镜手术，切除完整的寄生囊肿，并进行全面探查以寻找整个脑室系统和蛛网膜下腔基底池中的更多囊尾蚴囊肿。无死亡或并发症发生。在1至5年的随访期内，所有7例患者均无症状。
软性脑内窥镜检查能够以微创方式进入脑室系统和蛛网膜下腔基底池，并切除脑室内神经囊尾蚴囊肿。软性内窥镜检查是治疗由第三脑室神经囊尾蚴病引起的布伦斯综合征的一种替代治疗方法。
