Kim D G, Paek S H, Chang K H, Wang K C, Jung H W, Kim H J, Chi J G, Choi K S, Han D H
Department of Neurosurgery, Seoul National University College of Medicine, Korea.
J Neurosurg. 1996 Dec;85(6):1066-71. doi: 10.3171/jns.1996.85.6.1066.
Cerebral sparganosis is a rare parasitic disease caused by infestation by the plerocercoid larva of Spirometra mansoni. The authors retrospectively analyzed 17 cases of cerebral sparganosis treated at Seoul National University Hospital between 1986 and 1994. The patients' ages at diagnosis ranged from 6 to 57 years (median 32 years) and the male/female ratio was 13:4. Diagnosis was based on radiological findings, serological test results, operative findings, and histopathological examinations. Characteristic magnetic resonance (MR) findings consisted of widespread white matter degeneration and cortical atrophy, mixed-signal lesion (low in the central and high in the peripheral regions on T2-weighted images) with irregular dense enhancement of central foci and changes in the location and shape of the enhancing lesion in follow-up studies. Ten patients underwent surgical removal of the parasitic lesion, six received medical treatment alone (five with praziquantel and one with antiepileptic drugs), and one underwent insertion of a ventriculoperitoneal shunt and a course of praziquantel. Follow-up periods ranged from 13 to 111 months (mean 49 months). Seven patients who underwent complete removal of the lesion, live worm, or degenerative worm with surrounding granuloma showed a favorable course. Patients who received medical treatment alone or incomplete removal exhibited progression in their neurological deficits and their seizures could not be controlled. Medication with praziquantel seemed to have no killing effect on live worms. The authors conclude that MR imaging is the most valuable modality for the early detection of cerebral sparganosis and that complete surgical removal of granuloma together with worms, whether they are alive or degenerative, is the treatment of choice.
脑裂头蚴病是一种由曼氏迭宫绦虫裂头蚴感染引起的罕见寄生虫病。作者回顾性分析了1986年至1994年在首尔国立大学医院接受治疗的17例脑裂头蚴病病例。诊断时患者年龄在6至57岁之间（中位数为32岁），男女比例为13:4。诊断基于影像学检查结果、血清学检测结果、手术所见及组织病理学检查。特征性磁共振（MR）表现包括广泛的白质变性和皮质萎缩、混合信号病变（在T2加权图像上中央低信号、周边高信号），中央病灶有不规则强化，以及随访研究中强化病灶的位置和形态变化。10例患者接受了寄生虫病灶的手术切除，6例仅接受药物治疗（5例用吡喹酮，1例用抗癫痫药物），1例接受了脑室腹腔分流术并进行了吡喹酮疗程治疗。随访时间为13至111个月（平均49个月）。7例完全切除病灶、活虫或退变虫及其周围肉芽肿的患者病情转归良好。仅接受药物治疗或切除不完全的患者神经功能缺损进展，癫痫无法控制。吡喹酮治疗似乎对活虫没有杀灭作用。作者得出结论，MR成像对于脑裂头蚴病的早期检测是最有价值的检查方法，完整手术切除肉芽肿及虫体（无论其存活或退变）是首选治疗方法。
