MEDICAL AND SURGICAL-TREATMENT IN NEUROCYSTICERCOSIS A MAGNETIC-RESONANCE STUDY OF 161 CASES

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.