Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin 10124, Italy.
Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin 10124, Italy.
Clin Neurol Neurosurg. 2024 May;240:108268. doi: 10.1016/j.clineuro.2024.108268. Epub 2024 Mar 29.
Extraparenchymal localization of neurocysticercosis (NCC) is rare in non-endemic areas. A case of mixed (intraventricular, IV, and subarachnoid basal, SAB) NCC was surgically treated using the neuroendoscope and a systematic review of the literature was performed with the aim to analyze the use of this instrument in the management of the extraparenchymal forms of the parasitic disease.
Medline and Embase databases were searched for studies where the neuroendoscope was used for the management of IV/SAB NCC cysts, either for the cerebrospinal fluid diversion or cyst removal. Cyst location, complete removal, cyst breakage during removal, intraoperative and postoperative complications, administration of antihelmintic therapy, outcome and follow-up period were extracted from the articles.
281 patients were treated by means of the neuroendoscope. 254 patients who were described in retrospective cohort studies, came all from endemic areas, with no significant difference between sexes. Mean age at surgery was 30.7 years. Of all cysts reported in retrospective studies, 37.9% were located in the fourth ventricle. An attempt of cyst removal was described in the 84.6% of cases and an endoscopic third ventriculostomy was performed in another 76.4%. A small number of complications were reported intraoperatively (9.1%) obtaining, but a good recovery was achieved at follow-up. Only 17 ventriculoperitoneal shunts were placed after the first procedure, defining a low risk of postoperative hydrocephalus even in case of partial cyst removal.
Neuroendoscopic removal of an extraparenchymal NCC cyst is a safe procedure that should be preferred for lateral and third ventricle localization and, in a specialized centre, even for a localization in the fourth ventricle if feasible. It is also efficient because of the possibility of performing an internal CSF diversion concomitantly to cyst removal, avoiding the complication registered with VPS. The need for cysticidal treatment after surgery should be addressed in a prospective study.
在非流行地区，神经囊虫病（NCC）的脑外定位很少见。一例混合（脑室、IV 和蛛网膜下腔基底、SAB）NCC 患者接受神经内镜手术治疗，对该疾病的脑外形式的管理中使用该仪器进行了系统评价。
在 Medline 和 Embase 数据库中搜索了使用神经内镜治疗 IV/SAB NCC 囊肿的研究，包括脑脊液分流或囊肿切除。从文章中提取囊肿位置、完全切除、切除过程中囊肿破裂、术中及术后并发症、抗寄生虫治疗的管理、结果和随访时间。
281 例患者接受神经内镜治疗。254 例在回顾性队列研究中描述的患者均来自流行地区，性别无显著差异。手术时的平均年龄为 30.7 岁。在回顾性研究中报告的所有囊肿中，37.9%位于第四脑室。84.6%的病例尝试切除囊肿，76.4%的病例行内镜第三脑室造口术。术中报告的并发症较少（9.1%），但在随访时恢复良好。首次手术后仅放置了 17 个脑室-腹腔分流管，即使部分囊肿切除，术后脑积水的风险也较低。
神经内镜切除脑外 NCC 囊肿是一种安全的手术，应优先用于侧脑室和第三脑室定位，并且在专门中心，即使在第四脑室可行的情况下也应优先选择。由于可以同时进行内部 CSF 分流和囊肿切除，避免了与 VPS 相关的并发症，因此该方法也是有效的。术后是否需要进行杀囊虫治疗应在前瞻性研究中进行评估。
