Martinez H R, Rangel-Guerra R, Arredondo-Estrada J H, Marfil A, Onofre J
Internal Medicine Department, Hospital Universitario U.A.N.L., Monterrey, Mexico.
J Neurol Sci. 1995 May;130(1):25-34. doi: 10.1016/0022-510x(94)00278-v.
In a prospective non-controlled study we have treated 161 consecutive cases of Active Neurocysticercosis (NCC) diagnosed by Magnetic Resonance (MR). Active NCC was classified in: (1) brain parenchymal cysts (85 cases); (2) ventricular cysts (24 cases); (3) subarachnoid cysts (46 cases); and (4) cysticercus racemose (6 cases). All patients had MR follow up 1 month after treatment. Twenty five patients had MR with gadopentetate dimeglumine (Gd) contrast enhancement. Cine MR was performed in one patient. Medical treatment with albendazole (ABZ) or Praziquantel (PZQ) was applied in 136 cases. Drug efficacy, assessed by disappearance of the lesion on MR, was 92.5% with ABZ and 60% with PZQ. Thirty patients were treated by surgery. Five patients of group I were treated surgically due either to refractory seizures or persistent abnormalities on MR. Ventricular cysts were removed in 20 cases; 4 cases with cysticercus racemose and one with subarachnoid spinal cyst were also treated by surgery. Two patients with 4th ventricle cysts received ABZ and ventricular shunt only. Two cases with intraventricular cysts (lateral ventricles) and two with racemose cysts were successfully treated with ABZ. The Gd infusion showed enhancement in cysts with adjacent inflammatory reaction or edema and in cases with meningeal inflammation. Cine MR was useful in the differential diagnosis with congenital arachnoid cyst. We conclude that (1) MR is sensitive in the diagnosis of active NCC and may be useful in evaluating degenerative changes in the parasite; (2) ABZ is highly effective in the treatment of parenchymal and subarachnoidal NCC; (3) Parenchymal lesions which remain with abnormal appearance on MR (Degenerative cysticerci or gliosis) and refractory seizures should be treated by surgery; (4) Cysticercus racemose without intracranial hypertension may be treated with ABZ; (5) Ventricular cysts are treated by surgical removal, however, ABZ and ventricular peritoneal shunt may also be an alternative approach.
在一项前瞻性非对照研究中，我们对161例经磁共振成像（MR）诊断的活动性神经囊尾蚴病（NCC）连续病例进行了治疗。活动性NCC分为：（1）脑实质囊肿（85例）；（2）脑室囊肿（24例）；（3）蛛网膜下腔囊肿（46例）；（4）葡萄状囊尾蚴（6例）。所有患者在治疗后1个月进行了MR随访。25例患者进行了钆喷酸葡胺（Gd）增强MR检查。1例患者进行了电影MR检查。136例患者采用阿苯达唑（ABZ）或吡喹酮（PZQ）进行药物治疗。根据MR上病变消失情况评估的药物疗效，ABZ为92.5%，PZQ为60%。30例患者接受了手术治疗。I组中的5例患者因难治性癫痫发作或MR上持续异常而接受了手术治疗。20例患者切除了脑室囊肿；4例葡萄状囊尾蚴病患者和1例蛛网膜下腔脊髓囊肿患者也接受了手术治疗。2例第四脑室囊肿患者仅接受了ABZ和脑室分流术。2例脑室内囊肿（侧脑室）患者和2例葡萄状囊肿患者采用ABZ治疗成功。Gd注入显示，在伴有相邻炎症反应或水肿的囊肿以及伴有脑膜炎症的病例中出现强化。电影MR有助于与先天性蛛网膜囊肿进行鉴别诊断。我们得出结论：（1）MR对活动性NCC的诊断敏感，可能有助于评估寄生虫的退行性变化；（2）ABZ对实质型和蛛网膜下腔型NCC的治疗非常有效；（3）MR上仍有异常表现的实质病变（退行性囊尾蚴或胶质增生）和难治性癫痫发作应采用手术治疗；（4）无颅内高压的葡萄状囊尾蚴病可用ABZ治疗；（5）脑室囊肿采用手术切除治疗，然而，ABZ和脑室腹腔分流术也可能是一种替代方法。
