Spinal cord cysticercosis: neurosurgical aspects

Abstract

Object The authors report their experience in the treatment of 12 symptomatic patients with intradural spinal neurocysticercosis. Methods The mean age of the 12 patients was 33 years. There were eight female and four male patients. Cysticercosis was present in association with hydrocephalus in nine cases. In nine of 12 patients the spinal lesion was confined to the thoracic or lumbar spinal cord, and in three the cysticerci occupied the cervical region. In all patients with hydrocephalus nerve root symptoms developed seven to 48 months later (mean 27.6 ± 15.5 months). In one patient hydrocephalus was absent, but he presented with cysticercal meningitis 24 months before spinal cord compression developed. Presenting symptoms suggesting spinal cysticercosis included muscular weakness (67%), pain (67%), and sphincter disturbance (25%). Neurological examination demonstrated a motor deficit in nine patients, sensory deficit in four, and radicular pain in three. The prognosis was worse in patients with moderate-to-severe arachnoiditis and spinal cord compression compared with those with isolated nerve roots involvement in whom outcome was favorable. Ten patients underwent laminectomy, after which neurological status improved in 44%, remained unchanged in 33%, or worsened in 22.2%. Conclusions The authors discuss their findings in these cases. Additionally they briefly review the literature, patho-physiology, and therapeutic and/or surgical strategies involved in this disease.