Intraventricular Neurocysticercosis: Comparative Analysis of Different Localizations. Clinical Course and Treatment. A Systematic Review

Abstract

Abstract Background Neurocysticercosis is significant due to its high prevalence and considerable morbidity and mortality. The intraventricular form of NCC is less common than parenchymal, may have a rapidly progressive course and it requires a corresponding therapeutic response. Despite the extensive literature dealing with NCC and intraventricular cystic lesions, no systematic reviews have addressed similar work related to the clinical course and treatment of the infestation. Our main objective was to analyze the clinical type of the disease and the management for each ventricle separately on the basis of case reports or series of patients with individual data on the course of the disease and its treatment. As a control group, we used data on signs&symptoms and treatment of patients from published series on intraventricular neurocysticercosis. Method We performed a search in the Medline database. Google Scholar was also randomly searched. We extracted the following data from the eligible case/series: age and gender, symptoms, clinical signs, diagnostic examinations and findings, localization, treatment, follow-up period, outcome, and publication year. All data are presented in the form of absolute and relative numbers. The frequency of signs and symptoms, treatment and outcomes of the observed groups were checked by the Chi-square test and Fisher's test. The hypothesis was tested with p <0.05 as statistical significance. Results 158 cases of isolated and mixed forms of neurocysticercosis were divided into five categories. Hydrocephalus was recognized in 133 (84.2%). Patients with isolated IVNCC were younger (P=.0264) and harbored a higher percentage of vesicular cysts(p <.00001).In mixed IVNCC, the ratio was in favor of degenerative and/or multiple confluent cysts (p = 0.00068). Patients harboring fourth +third ventricle cyst (potentially obstructive form) are younger than lateral ventricle individuals(possibly less obstructive form) ( p = .0083). Most patients had individual symptoms for a long period before the acute onset of the disease (p <.00001). The dominant clinical manifestations are headache 88.5%, vomiting and nausea (56.1%), altered state of consciousness (44.6%), and focal neurological deficit (37.2%). The altered level of consciousness and the focal neurologic deficit was the only clinical manifestations with statistical significance (p= .0010 and p=0398 respectively)). Endoscopy (49.1%) was an elective surgical procedure with statistical significance within the study groups (p <0.001). Forty-six (29.2%) subjects underwent standard microsurgery, the fourth ventricle was the dominant site of intervention (p <0.001). Postoperatively, 39 (24.5%) received anti-helminthic drugs in combination with/without anti-inflammatory medication and other drugs. Endoscopy, open surgery, and postoperative antiparasitic therapy showed statistical differences (p <0.001). Favorable outcomes or regression of symptoms were observed in 79.9%; the mortality rate was 6.3%. Regarding the case series, clinical manifestations were as follows headache-64.%, nausea& vomiting 48.4%, focal neurologic deficit 33.6%, and altered level of consciousness 25%. Open surgery was the dominant form of intervention (craniotomy (57.6% or endoscopy 31.8%); with statistical significance between them(p< .00001). Conclusion Ventricular neurocysticercosis is an alarming clinical condition. Hydrocephalus is the dominant diagnostic sign. Isolated IVNCC patients were recognized at a younger age than Mix.IVNCC individuals; with cysts in the fourth and third ventricles (as a potentially more occlusive type of disease), presented their symptoms at a younger age than individuals with LVNCC. The parasites in its vesicular stage are located predominantly in isolated IVNCC, while degenerative and multiple confluent cysts are the main feature of Mix.IVNCC. The majority of patients had long-term signs and symptoms before the acute onset of the disease. Headache, nausea& vomiting are the most common symptoms of infestation accompanied by altered sensorium and focal neurological deficits. Surgery is the best treatment option. A sudden increase in ICP due to cerebrospinal fluid obstruction with a successive cerebral hernia is the leading cause of fatal outcomes.