Diagnosis and stereotactic aspiration treatment of cerebral sparganosis: summary of 11 cases.

Object: Cerebral sparganosis is a rare but underestimated parasitic disease caused by infestation by sparganum. It is difficult to make a confirmed preoperational diagnosis of this disease given the absence of characteristic clinical manifestations. A detailed protocol for the diagnosis and treatment of cerebral sparganosis is still lacking in the literature. In this article the authors set out comprehensive procedures for the diagnosis and treatment of cerebral sparganosis, describing the use of a stereotactic aspiration technique complemented by microsurgery based on experience gained from multiple cases.

Methods: The disease history, clinical manifestations, imaging features, and therapeutic procedures for 11 patients with cerebral sparganosis were retrospectively analyzed. Stereotactic aspiration procedures were performed in all 11 patients and were complemented by microsurgeries in 3 patients. The learning and experience gained from these treatments were summarized, and a comprehensive protocol for the diagnosis and treatment of cerebral sparganosis was reviewed.

Results: Larvae of Spirometra mansoni were taken from all 11 patients: completely removed in 10 cases and partially removed in 1 case (discovered later). After surgery, clinical symptoms in all 11 patients were significantly improved. All epileptic symptoms were successfully cured, although in 1 case occasional seizures still occurred because of the incomplete removal of the larva. Muscle strength in the 4 patients who had hemiparesis prior to surgery recovered to normal. Symptoms in the 1 patient who had presented with partial body sensory disturbance resolved after surgery. There were no complications or deaths.

Conclusions: The authors concluded that an effective preoperative diagnosis of cerebral sparganosis can be made by detailed inquiry into the possible infection history and disease symptoms as well as careful scrutiny of characteristic radiological features and immunological testing results. In stereotactic operations performed to remove the larva, priority should be given to image-guided stereotactic aspiration given that it causes the smallest wounds. In cases in which stereotactic aspiration fails, stereotactic microsurgery should be performed to remove the larva. The surgeon must carefully avoid breaking the larva and leaving behind any larva residue during surgery.