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Burgos-Sosa E, Bergna-Vazquez P, Mendizabal-Guerra R, Ayala-Arcipreste A. Microsurgical and endoscopic-assisted supraorbital keyhole approach for intra-suprasellar cysticercosis. Surg Neurol Int 2023; 14:328. [PMID: 37810297 PMCID: PMC10559371 DOI: 10.25259/sni_484_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background Treatment for intra/suprasellar cysticercosis can be challenging and may result in visual disturbances if not managed properly. Despite its limited knowledge, an effective surgical option exists to treat this condition. This article presents three cases of sellar cysticercosis, comprising one female and two male patients, managed with microsurgical supraorbital keyhole approach (mSKA) and endoscopic-assisted supraorbital keyhole approach (eaSKA). Case Description The first patient is a 35-year-old man with no prior medical history who suffered from memory deficits and visual disturbances due to a sellar cyst pushing the orbitofrontal gyrus treated with mSKA. The second case involved a 52-year-old man who experienced visual deficits caused by a rostral sellar cyst with posterior displacement of the pituitary gland treated with eaSKA. The third case was a 46-year-old woman who experienced decreased visual acuity and memory loss due to multifocal neurocysticercosis (NCC) with sellarsuprasellar cyst extension treated with mSKA. All case diagnoses were confirmed by neuropathology department. Conclusion The authors confidently suggest that the SKA is an effective surgical option and could be considered for removing sellar cystic lesions with suprasellar extension. With endoscopic assistance, it improves adequate neurovascular structure visualization.
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Affiliation(s)
- Erik Burgos-Sosa
- Department of Neurosurgery, Hospital Juárez de México, Instituto Politécnico Nacional, Mexico City, Mexico
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Goulart LC, Vieira Netto LA, Dias CRG, Moraes LFM, Marques RAS, Leão STSL, Alencar HS, Godoy CSM, Cavalcante RAC. Endoscopic endonasal approach for isolated subarachnoid neurocysticercosis in basal cisterns and its complications: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE2229. [PMCID: PMC9379711 DOI: 10.3171/case2229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Neurocysticercosis (NCC) is an infectious parasitic disease in which humans are the middle host in the life cycle of Taenia solium. It is currently considered to be a neglected tropical disease. According to their location, cysts can cause epilepsy, hydrocephalus, arachnoiditis, and intracranial hypertension. The subarachnoid is the rarest and most morbid form among all forms of NCC presentation.
OBSERVATIONS
The authors report an odd case of subarachnoid NCC (SUBNCC). It was treated with expanded endoscopic endonasal surgery. Unfortunately, the patient developed a high-output nasal leak and meningitis after cyst removal, which demanded additional surgical procedures. Nonetheless, the patient showed a good clinical outcome after surgical interventions.
LESSONS
Endoscopic endonasal approach of SUBNCC can be safe and curative. Neverthless, the presented report shows that severe complications can arise from the procedure. The authors hypothesized that placing an early cerebrospinal shunt would reduce the patient’s morbidity before difficulties arose.
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Affiliation(s)
- Lissa C. Goulart
- Department of Neurological Surgery, Clinics Hospital of the Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Caio R. G. Dias
- Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Luiza F. M. Moraes
- School of Medical and Life Sciences, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil; and
| | - Romulo A. S. Marques
- Department of Neurological Surgery, Clinics Hospital of the Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Simon T. S. L. Leão
- Department of Neurological Surgery, Clinics Hospital of the Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Helioenai S. Alencar
- Department of Neurological Surgery, Clinics Hospital of the Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Cássia S. M. Godoy
- Department of Infectious Diseases, Araújo Jorge Hospital, Goiânia, Goiás, Brazil
| | - Rodrigo A. C. Cavalcante
- Department of Neurological Surgery, Clinics Hospital of the Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
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Snyder MH, Marino AC, Shepard MJ, Amoakohene P, Berry DM, Mukherjee S, Mattos JL, Jane JA. Neurocysticercosis Presenting as an Isolated Suprasellar Lesion. World Neurosurg 2020; 141:352-356. [PMID: 32522639 DOI: 10.1016/j.wneu.2020.05.212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although extraparenchymal neurocysticercosis (NCC) is well established, presentation in the suprasellar space is rare. When presenting in the suprasellar space, the imaging characteristics may mimic more common lesions including craniopharyngioma and Rathke cleft cyst depending on the life cycle of the parasite. Although antiparasitic medical therapy may be effective for viable NCC, it is not routinely employed for calcified NCC. CASE DESCRIPTION This report presents a 39-year-old male patient who presented with profound visual decline secondary to a partially calcified suprasellar NCC. Suprasellar NCC was presumed based on specific radiologic findings, which are discussed. Medical therapy was not offered because of the proximity to the optic chiasm and the partial calcification of the lesion leading to the presumption that the mass was nonviable. The patient underwent successful endoscopic endonasal resection of the suprasellar NCC and experienced significant improvement in vision. Despite the calcification, pathological evaluation revealed that a portion remained viable. CONCLUSIONS Regardless of the life cycle stage, endonasal resection offers a minimally invasive approach for suprasellar NCC; treatment can be tailored to the patient's presentation and stage of infection.
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Affiliation(s)
- M Harrison Snyder
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Alexandria C Marino
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Matthew J Shepard
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Peggy Amoakohene
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Debra M Berry
- Division of Neuropathology, Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sugoto Mukherjee
- Division of Neuroradiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jose L Mattos
- Division of Rhinology and Endoscopic Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - John A Jane
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
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Del Brutto OH. Current approaches to cysticidal drug therapy for neurocysticercosis. Expert Rev Anti Infect Ther 2020; 18:789-798. [DOI: 10.1080/14787210.2020.1761332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo, Ecuador, Samborondón, Ecuador
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Del Brutto OH, Del Brutto VJ. Intrasellar cysticercosis: a systematic review. Acta Neurol Belg 2013; 113:225-7. [PMID: 23605125 DOI: 10.1007/s13760-013-0199-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
The objective of this study was to review patients with intrasellar cysticercosis to outline the features of this form of neurocysticercosis. A MEDLINE and manual search of patients with intrasellar cysticercosis were done. Abstracted data included clinical manifestations, neuroimaging findings, therapy, and outcome. Twenty-three patients were reviewed. Ophthalmological disturbances, including diminution of visual acuity and visual field defects following a chiasmatic pattern, were recorded in 67 % of cases. Endocrine abnormalities were found in 56 % of patients (panhypopituitarism, hyperprolactinemia, diabetes insipidus, and isolated hypothyroidism). In addition, some patients complained of seizures or chronic headaches. Neuroimaging studies showed lesions confined to the sellar region in 47 % of cases. The remaining patients also had subarachnoid cysts associated or not with hydrocephalus, parenchymal brain cysts, or parenchymal brain calcifications. Thirteen patients underwent surgical resection of the sellar cyst through a craniotomy in nine cases and by the transsphenoidal approach in four. Visual acuity or visual field defects improved in only two of these patients. Five patients were treated with cysticidal drugs without improvement. Intrasellar cysticercosis is rare and probably under-recognized. Clinical manifestations resemble those caused by pituitary tumors, cysts, or other granulomatous lesions. Neuroimaging findings are of more value when intrasellar cysts are associated with other forms of neurocysticercosis, such as basal subarachnoid cysts or hydrocephalus. Prompt surgical resection is mandatory to reduce the risk of permanent loss of visual function. There seems to be no role for cysticidal drug therapy in these cases.
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Neurocysticercosis, meningioma, and silent corticotroph pituitary adenoma in a 61-year-old woman. Case Rep Pathol 2012; 2012:340840. [PMID: 23346440 PMCID: PMC3546452 DOI: 10.1155/2012/340840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/15/2012] [Indexed: 01/14/2023] Open
Abstract
We report here the case of a 61-year-old woman who presented with hydrocephalus and cystic and solid lesions in sella turcica, suprasellar areas, and third ventricle. After ventriculoperitoneal shunt she developed cognitive changes and the cystic lesions enlarged. Magnetic resonance imaging (MRI) demonstrated multiple cysts and a solid lesion in the sella and around the anterior clinoid process. With diagnosis of neurocysticercosis she underwent craniotomy. Pathologic examination documented two different lesions: viable and dead cysticerci with inflaming infiltration and a left anterior clinoidal meningioma. At the second surgery, six weeks later via transnasal transsphenoidal approach a silent corticotroph pituitary adenoma was removed which was studied by histology, immunohistochemistry, and electron microscopy. To our knowledge, the occurrence of these three different lesions in the sellar area was not described before.
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Clinical Manifestations, Diagnosis, and Treatment of Neurocysticercosis. Curr Neurol Neurosci Rep 2011; 11:529-35. [DOI: 10.1007/s11910-011-0226-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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