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Endoscopic approach to fourth ventricle cysticercosis Translated title: Tratamento endoscópico da cisticercose do quarto ventrículo

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      Abstract

      Neurocysticercosis is the most frequently observed parasitosis of the central nervous system worldwide. The fourth ventricle is the most frequent site of intraventricular infestation, a location that carries a higher risk for CSF blockage and intracranial hypertension due to CSF blockage. A great number of patients become shunt dependent which carries a poorer prognosis. We report on a case of a patient with symptomatic obstructive hydrocephalus due to cysticercus in the fourth ventricle where an endoscopic approach via a frontal burr hole was performed. Although there is no consensus in the literature for the optimal treatment of this disease, this method seemed adequate for treatment of fourth ventricle cysticercosis in patients with hydrocephalus, aqueductal and foramen of Monro dilatations.

      Translated abstract

      A neurocisticercose é a parasitose mais freqüentemente encontrada no sistema nervoso central. O quarto ventrículo é o local mais frequente de infestação intraventricular, uma localização que acarreta grande risco de bloqueio da circulação liquórica e subseqüente hipertensão intracraniana. Grande número de pacientes se torna dependente de derivações liquóricas, o que determina pior prognóstico. Relatamos o caso de um paciente com quadro de hidrocefalia obstrutiva secundária a cisticerco localizado no quarto ventrículo que foi abordado por via endoscópica. Apesar de, até o momento, não haver consenso na literatura sobre o melhor tratamento da neurocisticercose intraventricular, o tratamento neuroendoscópico parece ser método eficaz de tratamento nos pacientes com hidrocefalia e dilatação dos forames de Monro e do aqueduto.

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      Most cited references 28

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      Epidemiology of neurocysticercosis in Brazil

      A revision of literature was done with the objective of tracing an epidemiologic profile of neurocysticercosis (NCC) in Brazil. The prevalence was 0.12-9% in autopsies. The frequency was 0.03-7.5% in clinical series and 0.68-5.2% in seroepidemiological studies. The disease corresponds to 0.08-2.5% of admissions to general hospitals. Patient origin was rural in 30-63% of cases. The most involved age range (64-100%) was 11 to 60 years, with a predominance (22-67%) between 21 and 40 years. The male sex was the most affected (51-80%). In the severe forms there was a predominance of urban origin (53-62%) and of the female sex (53-75%). The period of hospitalization ranges from 1 to 254 days and 33 to 50% of patients suffer 1.7 ± 1.4 admissions. The clinical picture was variable, with a predominance of epileptic syndrome (22-92%) and intracranial hypertension (19-89%). Psychiatric manifestations were associated in 9-23% of patients. Lethality was 0.29% in terms of all diseases in general and 4.8-25.9% in terms of neurologic diseases. The asymptomatic form was detected in 6% of patients in clinical serie and in 48.5% of case from autopsies. The racemose form and ventricular localization also was observed as asymptomatic form. Among the patients with cutaneous cysticercosis 65% of them showed neurologic manifestations.
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        Endoscopic removal of cysticercal cysts within the fourth ventricle. Technical note.

         M Bergsneider (1999)
        There is no consensus as to the optimum management of patients who harbor cysticercal cysts within the fourth ventricle. Compared with the alternative treatment options of anthelmintic medication and/or cerebrospinal fluid shunt placement, the surgical removal of the cyst has the advantage of eliminating the inflammatory nidus and potentially obviating the need for a complication-prone shunt. Here, an endoscopic surgical approach is described and proposed as an alternative to the standard suboccipital craniectomy for removal of cysticercal cysts within the fourth ventricle. A retrospective analysis of five consecutive endoscopic cases was performed. Endoscopic removal of all cysts within the fourth ventricle was successful in each case. The mean length of operative time was short and blood loss was insignificant. The endoscopic procedure was safe and associated with minimal postoperative discomfort in most patients. In properly selected patients, the endoscopic removal of cysticercal cysts located within the fourth ventricle should be considered as the primary treatment for this condition.
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          Neurosurgical considerations of cysticercosis of the central nervous system.

           W E Stern (1981)
          Infestation of the central system (CNS) by the larval form of Taenia solium can be etiological for one or more of several clinicopathological manifestations. Experience gained from treating 18 patients forms the basis for a classification of this disease and for observations upon therapy. Twenty-three surgical procedures in 15 of the 18 patients provide the foundation for comment on operative treatment in management. Whereas most procedures are palliative, eradication of the CNS disease may be achieved in cases of solitary intraventricular cysts. There has been no operative mortality.
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            Author and article information

            Affiliations
            [1 ] Universidade Federal de São Paulo Brazil
            Contributors
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Journal
            anp
            Arquivos de Neuro-Psiquiatria
            Arq. Neuro-Psiquiatr.
            Academia Brasileira de Neurologia - ABNEURO (São Paulo )
            1678-4227
            June 2003
            : 61
            : 2A
            : 204-207
            S0004-282X2003000200009
            10.1590/S0004-282X2003000200009

            http://creativecommons.org/licenses/by/4.0/

            Product
            Product Information: SciELO Brazil
            Categories
            NEUROSCIENCES
            PSYCHIATRY

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