Endoscopic management of cysticercal cysts within the lateral and third ventricles

Object. In this report the authors review their 3-year experience with the endoscopic management of patients with hydrocephalus who harbored cysticerc al cysts within the third and lateral ventricles. The management plan was t o utilize an endoscopic approach to remove the cysts and to incorporate tec hniques useful in treating obstructive hydrocephalus. The ultimate goals we re to avoid having to place a complication-prone cerebrospinal fluid shunt and to eliminate the risk of complications related to cyst degeneration. Methods. A retrospective analysis of 10 patients with hydrocephalus and cys ticercal cysts within the third or lateral ventricles who were endoscopical ly managed was performed. A general description of the instrumentation and technique used for removal of the intraventricular cysts is given. At prese ntation, neuroimaging revealed findings suggestive of obstructive hydroceph alus in eight patients. Seven of the 10 patients treated endoscopically were spared the necessity o f shunt placement. Three successful third ventriculostomies and one therape utic septum pellucidotomy were performed. Despite frequent rupture of the c yst walls during removal of the cysts, there were no cases of ventriculitis . The endoscopic approach allowed successful removal of a cyst situated in the roof of the anterior third ventricle. One patient suffered from recurre nt shunt obstructions secondary to a shunt-induced migration of cysts from the posterior fossa to the lateral ventricles. Conclusions. The endoscopic removal of third and lateral ventricle cysticer cal cysts, combined with a third ventriculostomy or septum pellucidotomy in selected cases, is an effective treatment in patients with hydrocephalus a nd should be considered the primary treatment for this condition.