Surgical Treatment

Medical therapy alone may not be effective for ventricular or spinal cord cysts. Ventricular shunting or extirpation of cysts should be considered for patients with cysts in the ventricles, spinal cord or orbits, and for patients with encephalitic or racemose forms of NCC. Steroids and aggressive management of hydro-cephalus, with ventricular shunting, if indicated, should be performed prior to administration of anthelmintics, as anthelmintics may exacerbate inflammation.

Fifteen percent of people with NCC have cysts in the ventricular system; the majority are located in the fourth ventricle. Cysts within the ventricles are often difficult to visualize with neuroimaging, but can usually be identified if imaging with intraventricular contrast is performed at the time of shunting [25]. Ventricular shunting for patients with NCC is frequently complicated by bacterial shunt infection and as many as 68% of patients may require shunt revision. Cysts in the spinal cord can cause symptoms of radiculopathy or myelopathy and are most often diagnosed at the time of extirpation. Surgical extirpation of cysts in the spinal cord or orbit is usually required, as medical treatment alone may not be effective and inflammation associated with medical treatment may cause worsening of symptoms or loss of vision. The encephalitic form of NCC is most often seen in young girls and is characterized by numerous intraparenchymal cysts and diffuse cerebral edema.

Table 36.7. Cerebrospinal fluid abnormalities in neurocysticercosis.

CSF findings

%

Normal

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