Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
World Neurosurg. 2020 Sep;141:352-356. doi: 10.1016/j.wneu.2020.05.212. Epub 2020 Jun 6.
Although extraparenchymal neurocysticercosis (NCC) is well established, presentation in the suprasellar space is rare. When presenting in the suprasellar space, the imaging characteristics may mimic more common lesions including craniopharyngioma and Rathke cleft cyst depending on the life cycle of the parasite. Although antiparasitic medical therapy may be effective for viable NCC, it is not routinely employed for calcified NCC.
This report presents a 39-year-old male patient who presented with profound visual decline secondary to a partially calcified suprasellar NCC. Suprasellar NCC was presumed based on specific radiologic findings, which are discussed. Medical therapy was not offered because of the proximity to the optic chiasm and the partial calcification of the lesion leading to the presumption that the mass was nonviable. The patient underwent successful endoscopic endonasal resection of the suprasellar NCC and experienced significant improvement in vision. Despite the calcification, pathological evaluation revealed that a portion remained viable.
Regardless of the life cycle stage, endonasal resection offers a minimally invasive approach for suprasellar NCC; treatment can be tailored to the patient's presentation and stage of infection.
虽然脑实质外神经囊虫病（NCC）已得到广泛认识，但发生于鞍上区者较为罕见。当发生于鞍上区时，根据寄生虫的生命周期，其影像学特征可能类似于更常见的病变，包括颅咽管瘤和 Rathke 裂囊肿。尽管针对活的囊尾蚴，抗寄生虫药物治疗可能有效，但对于钙化的囊尾蚴通常不采用该方法。
本报告介绍了 1 例 39 岁男性患者，因部分钙化的鞍上 NCC 而出现严重视力下降。根据特定的影像学发现推测为鞍上 NCC，这些发现将在文中讨论。由于病变靠近视交叉且部分钙化，认为该肿块已无活力，故未采用药物治疗。患者接受了成功的经鼻内镜下鞍上 NCC 切除术，视力显著改善。尽管存在钙化，但病理评估显示部分仍具有活力。
无论生命周期阶段如何，经鼻内镜手术为鞍上 NCC 提供了一种微创方法；可根据患者的表现和感染阶段来定制治疗方案。
