Hr. Martinez et al., MEDICAL AND SURGICAL-TREATMENT IN NEUROCYSTICERCOSIS A MAGNETIC-RESONANCE STUDY OF 161 CASES, Journal of the neurological sciences, 130(1), 1995, pp. 25-34
In a prospective non-controlled study we have treated 161 consecutive
cases of Active Neurocysticercosis (NCC) diagnosed by Magnetic Resonan
ce (MR). Active NCC was classified in: (1) brain parenchymal cysts (85
cases); (2) ventricular cysts (24 cases); (3) subarachnoid cysts (46
cases); and (4) cysticercus racemose (6 cases). All patients had MR fo
llow up 1 month after treatment. Twenty five patients had MR with gado
pentetate dimeglumine (Gd) contrast enhancement. Cine MR was performed
in one patient. Medical treatment with albendazole (ABZ) or Praziquan
tel (PZQ) was applied in 136 cases. Drug efficacy, assessed by disappe
arance of the lesion on MR, was 92.5% with ABZ and 60% with PZQ. Thirt
y patients were treated by surgery. Five patients of group I were trea
ted surgically due either to refractory seizures or persistent abnorma
lities on MR. Ventricular cysts were removed in 20 cases; 4 cases with
cysticercus racemose and one with subarachnoid spinal cyst were also
treated by surgery. Two patients with 4th ventricle cysts received ABZ
and ventricular shunt only. Two cases with intraventricular cysts (la
teral ventricles) and two with racemose cysts were successfully treate
d with ABZ. The Gd infusion showed enhancement in cysts with adjacent
inflammatory reaction or edema and in cases with meningeal inflammatio
n. Cine MR was useful in the differential diagnosis with congenital ar
achnoid cyst. We conclude that (1) MR is sensitive in the diagnosis of
active NCC and may be useful in evaluating degenerative changes in th
e parasite; (2) ABZ is highly effective in the treatment of parenchyma
l and subarachnoidal NCC; (3) Parenchymal lesions which remain with ab
normal appearance on MR (Degenerative cysticerci or gliosis) and refra
ctory seizures should be treated by surgery; (4) Cysticercus racemose
without intracranial hypertension may be treated with ABZ; (5) Ventric
ular cysts are treated by surgical removal, however, ABZ and ventricul
ar peritoneal shunt may also be an alternative approach.