Endoscopic management of supratentorial ventricular neurocysticercosis: case series and review of the literature.

Objective: Despite the increasing popularity of neuroendoscopy, scarce documentation exists in the literature regarding successes and failures of this treatment modality for ventricular cysticercosis. Since July 2000, we instituted a specific endoscopic strategy for select patients with supratentorial ventricular disease. The goals of the strategy were to 1) remove ventricular cysts; 2) employ internal CSF diversion procedures for hydrocephalus to avoid shunting, and; 3) elude open surgical procedures.

Methods: A retrospective analysis of the charts of 7 patients managed with an endoscope for symptomatic hydrocephalus and supratentorial ventricular cysts was performed. A description of our management plan is given.

Results: From July 2000 through July 2002, we successfully resected all supratentorial ventricular cysts in 7 patients with an endoscope and employed three septostomies and four third ventriculostomies in the same sitting. None of the seven patients required shunting or further surgery to date. No case of postoperative ventriculitis occurred despite an 86 % cyst rupture rate. One cyst adjacent to the left foramen of Monro, which was successfully resected, produced significant intraventricular bleeding during surgical dissection. This patient developed akinetic mutism postoperatively, which improved with bromocriptine. The follow-up period was 16 months (range, 10 - 24 months).

Conclusions: The ease of performing septostomies and third ventriculostomies in conjunction with cyst removal makes these procedures appealing and practical for most cases of ventricular cysticercosis.