Intraventricular neurocysticercosis: a review of current status and management issues

Abstract

The infection of brain and its coverings by larval stage of tapeworm Taenia solium leads to Neurocysticercosis (NCC). The intraventricular form of NCC (IVNCC) has a rapidly progressive course and seen in 15-54% cases. This demands prompt management, as the patients usually present with features of raised intracranial pressure because of cyst load or occlusion of CSF pathways due to associated ependymitis and basal arachnoiditis. The commonest site of occurrence is in fourth ventricle. Neuroimaging is mainstay of diagnosis of IVNCC. The treatment depends on clinical presentation, location within the ventricular system and evolutionary stage of parasite. However, the efficacy of antihelminthic treatment in IVNCC may require further collaborative clinical trials. The decision to operate in a viable intraventricular cyst depends on the presence of: (i) mass effect (ii) CSF obstruction (iii) fourth ventricular cysts. Recently, endoscopic approaches have been the favorable treatment option for IVNCC with hydrocephalus as the clinical results far outbetter those for open approaches used previously.