Neuroendoscopic management of intraventricular neurocysticercosis: A systematic review and meta-analysis

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-05-09 DOI:10.1016/j.clineuro.2025.108953

Cristian D. Mendieta-Barrera , Anuraag Punukollu , Camila Rios-Hurtado , Fernando De Nigris Vasconcellos , Fabricio Garcia-Torrico , Vanessa Pamela Salolin-Vargas , Kevin Mamani-Julian , Carlos Esteban Vidal Valderrama , Luciana Rivera-Hurtado , Daniel Ballesteros-Herrera , Manjul Tripathi , Jaime G. Torres-Corzo , Arash Ghaffari-Rafi

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引用次数: 0

Abstract

Background

Neurocysticercosis is parasitic infection responsible for intraventricular cysts and consequent obstructive hydrocephalus. While the cysts are sometimes treated endoscopically, the efficacy and safety of neuroendoscopic management for intraventricular neurocysticercosis (IVNCC) remains unclear. Therefore, we conducted a systematic review and meta-analysis to evaluate management outcomes of endoscopic IVNCC.

Methods

Following PRISMA guidelines, a search of MEDLINE, Embase, and Lilacs databases was performed (inception to September 10, 2024), focusing on the neuroendoscopic management of IVNCC. Eligible studies included at least five patients and reported outcomes of cyst resection and complication rates.

Results

Fifteen studies met our inclusion criteria (n = 314 patients). Mean age at diagnosis was 20.6 years, with 55.6 % (n = 138) patients male, and 44 % (n = 138) of cysts in the fourth ventricle, 32.8 % (n = 104) in the third, and 28.7 % in the lateral ventricles. Preoperative hydrocephalus was observed in 92.3 % (n = 203) of cases. Complete cyst resection was achieved in 90.1 % (n = 214) of patients, with the highest success rates noted in third ventricular cysts (99.6 %; compared to 89.0 % in the lateral and 85.0 % in the fourth ventricles). Flexible endoscopy demonstrated superior outcomes for fourth ventricle cysts (100 %) relative to the rigid endoscope (79.0 %, p < 0.01). Non-visualization of cysts was the primary etiology for incomplete resection (1.6 %). Intraoperative complications included bleeding at 0.76 % (n = 6) and cyst rupture at 0.48 % (n = 5). Postoperative complications involved seizures (1.6 %), neurological deficits (0.95 %), and infection-related mortality (0.85 %). The reintervention rate was 3.0 % (n = 18), with the intervention primarily being cranial shunt implantation. Postoperative anthelmintic therapy significantly improved outcomes from 69.0 % to 96.0 % (p < 0.01).

Conclusion

Neuroendoscopic management of IVNCC is effective and safe. Higher resection rates are achieved with the flexible endoscope, likely secondary to enhanced visualization. Finally, adjuvant postoperative anthelmintic therapy significantly improved outcomes.

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脑室内神经囊虫病的神经内窥镜治疗：系统回顾和荟萃分析

神经囊虫病是一种寄生虫感染，可导致脑室内囊肿和随后的阻塞性脑积水。虽然囊肿有时在内窥镜下治疗，但神经内窥镜治疗脑室内神经囊虫病（IVNCC）的有效性和安全性尚不清楚。因此，我们进行了系统回顾和荟萃分析，以评估内镜下IVNCC的治疗结果。方法按照PRISMA指南，检索MEDLINE、Embase和Lilacs数据库（创建至2024年9月10日），重点研究IVNCC的神经内镜管理。符合条件的研究包括至少5例患者，并报告了囊肿切除和并发症发生率的结果。结果15项研究符合我们的纳入标准（n = 314例患者）。在诊断为20.6岁,平均年龄55.6 % (n = 138)患者男,44 % (n = 138)的第四脑室囊肿,32.8 % (n = 104)第三,侧脑室和28.7 %。术前脑积水发生率为92.3 % （n = 203）。90.1 % （n = 214）的患者完全切除了囊肿，其中第三脑室囊肿的成功率最高(99.6 %；侧脑室为89.0 %，第四脑室为85.0% %)。柔性内窥镜对第四脑室囊肿的治疗效果（100% %）优于刚性内窥镜（79. %,p <； 0.01）。囊肿不可见是不完全切除的主要原因（1.6 %）。术中并发症包括出血0.76 % （n = 6）和囊肿破裂0.48 % （n = 5）。术后并发症包括癫痫发作（1.6 %）、神经功能缺损（0.95 %）和感染相关死亡率（0.85 %）。再干预率为3.0 % (n = 18)，以颅分流器植入为主。术后驱虫药治疗显著改善了预后，从69.0% %提高到96.0 % （p <； 0.01）。结论神经内窥镜治疗IVNCC是安全有效的。使用柔性内窥镜可以获得更高的切除率，这可能是增强可视化的次要原因。最后，术后辅助驱虫药治疗可显著改善预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.