Surgical nuances of giant neurocysticercosis according to intracranial location in the Southwest region of the Dominican Republic, presentation of cases, and literature review

Abstract

Background: Neurocysticercosis (NCC) is the most common infestation of the central nervous system, caused by the larval stage of the pig tapeworm Taenia solium. It is prevalent in regions with poor sanitation and underdevelopment, such as Latin America.

Case description: We present four cases in which they harbored an intraventricular/intraparenchymal, frontal convexity, cerebellomedullary, and intraparenchymal NCC cyst of medium size, respectively. Three of them underwent complete removal of the cyst by craniotomy; the fourth had a shunt for obstructive hydrocephalus first, followed by excision of a suboccipital cyst 8 months later.

Conclusion: The intraventricular/intraparenchymal lesion was more complex to treat than its subarachnoid counterparts because the average brain should be transected and dissected away to achieve total removal. Waterjet dissection, arachnoid microdissection, and cyst drainage allowed minor brain damage than capsule coagulation and traction. Populated prospective studies are needed better to understand the surgical nuances of these rare entities.

Keywords: Cyst; Neurocysticercosis; Surgical technique; Taenia solium; Treatment.

Figure 1:

(a and b) Coronal view, T2- and T1-contrasted sequence magnetic resonance imaging (MRI) showing the intraventricular cyst, with scolex (yellow arrow). (c) Axial T1-contrasted MRI, the yellow arrow shows the giant cyst. (d) Excised cyst with intracapsular fluid drained (syringes). (e) Intraoperative exoscopic view of the cyst (blue dot) and the adjacent brain parenchyma (black star).

Figure 2:

(a) Axial T1 contrast-weighted magnetic resonance imaging (MRI) with mass effect cyst (yellow arrow) and (b) coronal view, T1-contrasted sequence MRI showing the giant cyst (yellow arrow). (c) Intraoperative view of the cyst (blue dot) and adjacent brain (black star). (d) Intraoperative view of compressed brain after complete cyst removal (black star). (e) Preoperative axial view of a head computed tomography (CT) scan showing the compressing cyst (yellow arrow). (f) Postoperative head CT scan demonstrating the complete cyst removal.

Figure 3:

(a) Preoperative axial view of a head computed tomography (CT) scan demonstrating an acute hydrocephalus (yellow arrow) secondary to neurocysticercosis (NCC) and (b) postoperative CT scan showing resolution (yellow arrow) after cerebrospinal fluid shunt. (c) Sagittal view of a T1-weighted magnetic resonance imaging (MRI) showing a racemose NCC in the cisterna magna, extending to the fourth ventricle (yellow arrows). (d) Axial fluid-attenuated inversion recovery MRI demonstrating an intraventricular cyst with surrounding ependymitis (e) intraoperative view of racemose NCC inside cisterna magna, before excision (f) intraoperative view after cyst resection, medulla oblongata (blue dot), left posteroinferior cerebellar artery (yellow arrow) with an atheromatous plaque and right cerebellar tonsil (black star).

Figure 4:

(a and b) Sagittal view of a T1-contrasted sequence magnetic resonance imaging showing a middle size neurocysticercosis cyst (yellow arrow). (c) Axial view of a head CT scan showing the cyst (yellow arrow) and surrounding brain edema (green arrows). (d) Postoperative CT scan demonstrating the complete resection of the cyst and (e) preoperative axial view of a head CT scan showing the compressing cyst (yellow arrow).