Neurosurgical Approach to Neurocysticercosis in Adults: A Comprehensive Systematic Review of Clinical and Imaging Insights.

Background And Objectives: Neurocysticercosis (NCC), caused by larval cysts of Taenia solium, presents a significant health challenge worldwide with diverse clinical presentations and varying management approaches. Untreated NCC can lead to increased intracranial pressure and/or hydrocephalus, with possible death. This review provides comprehensive neurosurgical insight into the heterogeneity of NCC. As there is currently no treatment algorithm for NCC, we propose a framework based on the management strategies most prevalent in the literature.

Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted searching PubMed, Scopus, and Embase from November 1993 to August 2023. Included articles had individual patient data on the treatments and outcomes of adult patients treated for confirmed symptomatic NCC. Relevant patient data on patient presentations, management, and outcomes and disease characteristics were collected.

Results: Our analysis included 90 studies with 205 patients. Neuroimaging was diagnostic for all, with MRI being predominant (74%). Cysts were intraparenchymal (n = 69), extraparenchymal (n = 68), spinal (n = 24), and mixed distribution (n = 16). Common symptoms included seizures (39%), headache (39%), and motor weakness/paresis (28%). 67 patients presented with hydrocephalus, 30 (45%) of which received a ventriculoperitoneal shunt. NCC was most commonly treated medically with corticosteroids (56%) and albendazole (55%). Neurosurgical intervention was most commonly performed for surgical extraction of cysts (33%). Combination of medical and surgical treatment (98%, 44/45) or surgical intervention alone (98%, 40/41) was the most successful at resolving symptoms after first treatment. Resolution of symptoms with added radiographic resolution of the cyst was common with maximal treatment (n = 137, 70%).

Conclusion: NCC's diverse presentations and outcomes emphasize the importance of tailored therapeutic strategies. Limitations of this study include its retrospective nature and low sample sizes of individual studies. The prominence of corticosteroids, albendazole, and surgical procedures highlights their central role in NCC management, as well as the indispensable role of neurosurgeons.