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Baro V, Anglani M, Martinolli F, Landi A, d'Avella D, Denaro L. The rolling cyst: migrating intraventricular neurocysticercosis-a case-based update. Childs Nerv Syst 2020; 36:669-677. [PMID: 31940056 DOI: 10.1007/s00381-020-04505-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/07/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neurocysticercosis is the most frequent parasitic disease of the central nervous system, and its incidence in the developed countries is increasing due to immigration and travels from endemic areas. The intraventricular location has been found to involve up to 61.3% of the patients; moreover, only 22 cases of migrating intraventricular cyst have been reported so far. Despite the rarity of the condition in western countries, its occurrence generates some concerns and the aim of this paper is to update the information concerning pathogenesis, clinical presentation, diagnosis and management of this entity. METHODS AND RESULTS All the pertinent literature was analysed, focused on the cases of migrating intraventricular neurocysticercosis and its peculiar features. An illustrative case regarding a 14-year-old girl is also presented. CONCLUSIONS Migrating intraventricular neurocysticercosis is a pathognomonic entity usually presenting with hydrocephalus, and its treatment is mainly surgical, preferring an endoscopic approach. When the resection of the intraventricular cyst is not performed, an accurate follow-up is mandatory to detect clinical changes due to a recurrent hydrocephalus or to the effect of the dying cyst on the surrounding area. In case of permanent shunt placement, the cysticidal and steroid treatment is recommended to reduce the risk of shunt failure.
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Affiliation(s)
- Valentina Baro
- Academic Neurosurgery, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy.
| | - Mariagiulia Anglani
- Neuroradiology Unit, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
| | - Francesco Martinolli
- Paediatric Emergency Department, Department of Woman's and Child's Health, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
| | - Andrea Landi
- Academic Neurosurgery, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
| | - Domenico d'Avella
- Academic Neurosurgery, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
| | - Luca Denaro
- Academic Neurosurgery, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
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Ratha V, Kumar VRR. Transventricular Migration of Choroid Plexus Carcinoma Causing an Intraoperative Conundrum: A Case Report with a Review of the Literature. Pediatr Neurosurg 2019; 54:341-346. [PMID: 31536979 DOI: 10.1159/000500300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/11/2019] [Indexed: 11/19/2022]
Abstract
Migrating intracranial tumors are extremely rare occurrences in the neurosurgery literature. Introduction of any factor causing disequilibrium in cerebrospinal fluid circulation and pressure can potentially precipitate transventricular migration of pedunculated intraventricular lesions. The identification of such factors, prior to excision of intraventricular pedunculated tumors, is imperative to avoid intraoperative mismanagement. We report an extremely rare case of transventricular migration of a choroid plexus carcinoma in an infant, possibly precipitated by a ventriculoperitoneal (VP) shunt on the opposite side. This resulted in intraoperative confusion and a subsequent re-exploration of the opposite side for excision of the tumor. The literature provided only two similar occurrences in the past; however, in both cases, the migration was within the same ventricle and was documented prior to definitive resection. We report the first instance of transventricular migration of a tumor to the opposite ventricle following VP shunt which resulted in a negative intraoperative finding requiring a subsequent re-intervention on the opposite side. We believe that for any pedunculated intraventricular lesion, where an emergency management of hydrocephalus takes priority, a repeat neuroimaging is a must prior to definitive resection.
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Affiliation(s)
- Vishwaraj Ratha
- Department of Neurosurgery, SRM Institute of Medical Sciences, Chennai, India,
| | - V R Roopesh Kumar
- Department of Neurosurgery, SRM Institute of Medical Sciences, Chennai, India
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Sharma BS, Sawarkar DP, Verma SK. Endoscopic Management of Fourth Ventricle Neurocysticercosis: Description of the New Technique in a Case Series of 5 Cases and Review of the Literature. World Neurosurg 2018; 122:e647-e654. [PMID: 30814022 DOI: 10.1016/j.wneu.2018.10.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Around 7%-33% of cases of neurocysticercosis (NCC) have intraventricular involvement, and the fourth ventricle is the most frequent site. Medical management and various surgical approaches have been described for treating this disease. The objective of this study was to describe technical modification for endoscopic fourth ventricular NCC removal in a series of 5 cases. METHODS In this study (January 1, 2016, to December 31, 2017), all cases of fourth ventricular NCC which were treated with a special technique (endoscopic transcortical transforaminal transaqueductal approach) using a rigid endoscope system and 6-French infant feeding tube (IFT) were included in the study. The IFT was passed through the main channel, the cyst was engaged at the tip by applying gentle suction with a 20 cm3 syringe, and the cyst was removed along with the whole endoscopic assembly. Patient's clinical, radiologic, and follow-up data were retrieved from the department database records. RESULTS Five patients (3 men, 2 women; mean age, 20 years; range, 11-27 years) were enrolled. All patients had features of raised intracranial pressure. Two patients also had drop attacks, and one presented with altered sensorium and one had upgaze palsy. Duration of symptoms ranged from 3 months to 3 years. All patients had isolated fourth ventricular NCC with obstructive hydrocephalus. Complete removal of the neurocysticercal cyst could be performed in all patients without any injury to the periaqueductal region or fornix. There was no intraoperative rupture of the neurocysticercal cyst. On follow-up (range, 12-28 months; mean, 19.4 months), all patients had relief of symptoms and imaging showed no cyst and hydrocephalus. CONCLUSIONS We conclude that our endoscopic approach is safe, simple, cost-effective, and allows minimally invasive removal of the fourth ventricle cyst and treatment of hydrocephalus without any morbidity.
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Affiliation(s)
- Bhawani Shanker Sharma
- Department of Neurosurgery and Gamma Knife Center, All India Institute of Medical Sciences, New Delhi, India
| | | | - Satish Kumar Verma
- Department of Neurosurgery and Gamma Knife Center, All India Institute of Medical Sciences, New Delhi, India
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Khalid S, Obaid A, Sharma RM, Mahmood A, Narayanasamy S. Intraventricular migration of an isolated fourth ventricular cysticercus following cerebrospinal fluid shunting. Surg Neurol Int 2016; 7:S952-S954. [PMID: 28031989 PMCID: PMC5180433 DOI: 10.4103/2152-7806.195232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/14/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Isolated intraventricular neurocysticercosis (NCC) is less frequently seen and can be missed on plain magnetic resonance imaging (MRI). Three-dimensional constructive interference in steady state (CISS) sequence is an extremely helpful sequence in identifying the lesion but is rarely used routinely. CASE DESCRIPTION Here, we report a case of young male adult who presented with diminution of vision and headache. MRI of the brain revealed hydrocephalus, and on using CISS sequence only, the lesion could be identified in the fourth ventricle. He was treated with medical management, and ventriculoperitoneal shunting of cerebrospinal fluid was done to relieve the hydrocephalus. It resulted in immediate relief with aggravation of headache few days later. Repeat MRI revealed intraventricular migration into the left foramen of monro leading to left lateral ventricle dilatation necessitating endoscopic removal of the lesion. CONCLUSION CISS sequence is definitely the sequence of choice in identifying intraventricular NCC. Ventriculoperitoneal shunting can result in the intraventricular migration of the cyst due to sudden decompression necessitating repeat surgery. Endoscopic removal of NCC has a high success rate with limited complications.
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Affiliation(s)
- Saifullah Khalid
- Department of Radiodiagnosis, J N Medical College, Aligarh, India
| | - Amber Obaid
- Department of Radiodiagnosis, J N Medical College, Aligarh, India
| | - Raman M Sharma
- Department of Neurosurgery, J N Medical College, Aligarh, India
| | - Asad Mahmood
- Department of Neurosurgery, J N Medical College, Aligarh, India
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Kurz C, Schmidt V, Poppert H, Wilkins P, Noh J, Poppert S, Schlegel J, Delbridge C, da Costa CP, Winkler AS. An Unusual Presentation of Neurocysticercosis: A Space-Occupying Lesion in the Fourth Ventricle Associated with Progressive Cognitive Decline. Am J Trop Med Hyg 2015; 94:172-5. [PMID: 26621562 DOI: 10.4269/ajtmh.15-0099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 10/09/2015] [Indexed: 11/07/2022] Open
Abstract
We communicate a case of a middle-aged Brazilian patient with an unusual presentation of fourth ventricular neurocysticercosis: occurrence of two intraventricular cysts at different locations in the brain within 2 years and cognitive decline as the only neurological symptom. Neurocysticercosis was confirmed by magnetic resonance imaging, serology, histology, and genetic analysis. Neurocysticercosis should be considered as a differential diagnosis in cases with atypical neurologic or psychiatric symptoms, atypical neuroimaging and travel history. Especially, fourth ventricular cysts carry the risk of obstructive hydrocephalus and brainstem compression and therefore should be extirpated completely. If complete removal of the cystic structures cannot be proven in cases with surgically treated neurocysticercosis, anthelminthic therapy and thorough follow-up examinations should be conducted.
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Affiliation(s)
- Carolin Kurz
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Veronika Schmidt
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Holger Poppert
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Patricia Wilkins
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany
| | - John Noh
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Sven Poppert
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Jürgen Schlegel
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Claire Delbridge
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Clarissa Prazeres da Costa
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany
| | - Andrea S Winkler
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Germany; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia; University Medical Center, Hamburg-Eppendorf, Germany; Division of Neuropathology, Institute of Pathology, Technical University Munich, Germany; Institute of Medical Microbiology, Immunology and Hygiene, Klinikum rechts der Isar, Technical University Munich, Germany
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