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Toledo A, Fragoso G, Carrillo-Mezo R, Romo ML, Sciutto E, Fleury A. Can sPD-1 and sPD-L1 Plasma Concentrations Predict Treatment Response among Patients with Extraparenchymal Neurocysticercosis? Pathogens 2023; 12:1116. [PMID: 37764924 PMCID: PMC10535301 DOI: 10.3390/pathogens12091116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/14/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Extraparenchymal neurocysticercosis (EP-NC) is a chronic, potentially life-threatening disease that responds poorly to initial anthelmintic drug therapy. A depressed specific reactivity of peripheral lymphocytes and an increased level of specific Tregs accompanies EP-NC. The immune checkpoint pathway PD-1 and its ligand PD-L1 downregulates effector T cells, causing specific immune suppression in chronic diseases. This study explored whether their soluble forms, sPD-1/sPD-L1, are present in plasma among patients with EP-NC and if their levels could be associated with treatment response. A total of 21 patients with vesicular EP-NC and 22 healthy controls were included. Patients received standard treatment and were followed for six months to assess treatment response by assessing changes in cyst volume determined with 3D MRI. The presence of both sPD-1 and sPD-L1 was more frequently detected among patients with EP-NC than in healthy controls and had higher concentrations. Among patients, higher pre-treatment levels of both markers were associated with a poor treatment response, and the sensitivity and specificity of the sPD-1/sPD-L1 ratio for predicting any response to treatment were high. Our results are consistent with the presence of lymphocyte exhaustion and open new research perspectives to improve the prognosis of patients with this severe disease.
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Affiliation(s)
- Andrea Toledo
- Unidad de Neuro Inflamación, Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigación Biomédicas, Universidad Nacional Autónoma de México (UNAM)/Instituto Nacional de Neurología y Neurocirugía, Ciudad de México 14269, Mexico
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Ciudad de México 04510, Mexico
| | - Gladis Fragoso
- Departamento de Inmunología, Instituto de Investigación Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México 04510, Mexico
| | - Roger Carrillo-Mezo
- Departamento de Neurorradiología, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México 14269, Mexico
| | - Matthew L Romo
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA
| | - Edda Sciutto
- Departamento de Inmunología, Instituto de Investigación Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México 04510, Mexico
| | - Agnès Fleury
- Unidad de Neuro Inflamación, Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigación Biomédicas, Universidad Nacional Autónoma de México (UNAM)/Instituto Nacional de Neurología y Neurocirugía, Ciudad de México 14269, Mexico
- Clínica de Neurocisticercosis, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México 14269, Mexico
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Singh DK, Kumar Sharma P, Singh N, Chand V. Intraventricular migration of fourth ventricular neurocysticercosis: an unusual complication during endoscopic surgery. BMJ Case Rep 2023; 16:e255813. [PMID: 37399344 PMCID: PMC10314531 DOI: 10.1136/bcr-2023-255813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
A boy in his middle childhood presented with intermittent episodes of headache with vomiting for 6 months. Plain CT of the head and MRI of the brain revealed fourth ventricular cysticercal cyst with acute obstructive hydrocephalus. Endoscopic excision of the cyst was done along with endoscopic third ventriculostomy and septostomy with external ventricular drain placement. Although we were able to decompress the cysticercal cyst, unfortunately, the cyst got slipped from the grasper leaving the grasped cyst wall in the tooth of the grasper. Through this case report, we want to highlight that such a complication could also happen during neuroendoscopic cysticercal cyst removal and how we dealt with it. Our patient was discharged neurologically intact and was symptom free on follow-up.
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Affiliation(s)
- Deepak Kumar Singh
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prevesh Kumar Sharma
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Singh
- Radiodiagnosis and Imaging, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vipin Chand
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Yamaki VN, Telles JPM, Yamashita RHG, Matushita H. Neurocysticercosis: challenges in pediatric neurosurgery practice. Childs Nerv Syst 2023; 39:743-750. [PMID: 36689000 DOI: 10.1007/s00381-022-05784-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/06/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Neurocysticercosis (NCC) is considered a neglected infectious disease, but the most common parasitic disease of the central nervous system (CNS). Due to oral tendencies in childhood, it is hypothesized that individuals are infected around this age and develop symptoms as lately as during young adulthood. Although it is considered a benign disease, it may cause great impact in the patient's quality of life due to epilepsy, visual symptoms, and hydrocephalus, which eventually requires frequent hospitalizations. The treatment of hydrocephalus is the main challenge for neurosurgeons. METHODS We performed a concise review on neurocysticercosis in children and the main presentations of NCC in the neurosurgery practice and a systematic review on hydrocephalus secondary to extraparenchymal NCC. RESULTS Our review showed a rate of complete resolution of hydrocephalus secondary to NCC of around 80% with the first attempt of surgical treatment combined with medication therapy. Endoscopic removal of the intraventricular cysts with third ventriculostomy was the most common treatment modality. Patients previously managed with ventricular shunts are likely to have worse outcomes and complications. CONCLUSION Endoscopic approach is the gold standard surgical treatment for hydrocephalus secondary to neurocysticercosis.
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Affiliation(s)
- Vitor Nagai Yamaki
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of São Paulo, Av. Dr. Eneas Carvalho de Aguiar 255, 05403900, São Paulo, Brazil
| | | | - Renata Harumi Gobbato Yamashita
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of São Paulo, Av. Dr. Eneas Carvalho de Aguiar 255, 05403900, São Paulo, Brazil
| | - Hamilton Matushita
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of São Paulo, Av. Dr. Eneas Carvalho de Aguiar 255, 05403900, São Paulo, Brazil.
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Disseminated Human Subarachnoid Coenurosis. Trop Med Infect Dis 2022; 7:tropicalmed7120405. [PMID: 36548661 PMCID: PMC9780974 DOI: 10.3390/tropicalmed7120405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/14/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Traditionally, human coenurosis has been ascribed to Taenia multiceps while neurocysticercosis has been attributed solely to Taenia solium infection. Historically, however, the identification and differentiation of cestodal infection was primarily based on inaccurate morphological criteria. With the increasing availability of molecular methods, the accuracy of identification of the larval cestode species has improved, and cestodal species not typically associated with central nervous system (CNS) infection are now being identified as aetiological agents. Case report: We present a case of a 5-year-old male patient who presented with acute hydrocephalus. Initial MRI revealed multiple cysts in the cerebrospinal fluid (CSF) spaces with a predominance of clumped grape-like cysts in the basal cisterns with resultant acute obstructive hydrocephalus. The child underwent an emergency ventriculo-peritoneal (VP) shunt. A presumptive diagnosis of neurocysticercosis racemosus was made and the child was started on empiric albendazole (15 mg/kg/day) and praziquantel (30 mg/kg/day) treatment, along with concomitant prednisone (1 mg/kg) treatment. Despite prolonged anti-helminthic therapy, the child continued to deteriorate, and endoscopic removal of the 4th ventricular cysts was required. Post-operative MRI revealed radiological improvements, with a reduction in the number and size of cysts, especially in the basal cisterns, with no cysts visualized in the fourth ventricle. DNA was extracted from CSF and cyst tissue using the QiAMP DNA mini kit (Qiagen). The PCR performed on the extracted DNA displayed a band of 275 bp on an agarose gel. The consensus sequence had 97.68% similarity to Taenia serialis 12S ribosomal RNA gene. The child, unfortunately, continued to do poorly, requiring multiple VP shunt revisions for repeated blockage of the VP shunt system, and ultimately demised, despite the ‘successful’ surgical intervention and continued maximal medical management. Discussion and conclusions: There have been approximately 40 reported cases of human CNS coenurosis, with the assumed etiological agent being confined to T. multiceps. In 2020, the first case of human CNS coenurosis caused by T. serialis was reported. This case involved a single parenchymal lesion in the occipital lobe, which, following complete surgical excision, was confirmed to be T. serialis by mitochondrial gene sequencing. The case we present is the first case of disseminated subarachnoid coenurosis caused by T. serialis. It appears that T. serialis infection can mimic either of the two basic pathological forms of neurocysticercosis, namely, cysticercosis cellulosae or cysticercosis racemosus. We postulate that the term coenurosis racemosus is applicable if CNS T. serialis infection presents with extensive, multiple grape-like bladders proliferating within the subarachnoid space.
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García-Pérez D, García-Posadas G, Paredes I, Jiménez-Roldán L. Racemose fourth ventricle neurocysticercosis excision through telovelar approach and hydrodissection. World Neurosurg 2022; 165:91. [PMID: 35717015 DOI: 10.1016/j.wneu.2022.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022]
Abstract
Intraventricular neurocysticercosis (NCC) is associated with more severe complications and a worse overall outcome.1,8 Fourth ventricle NCC (FVNCC) often presents with CSF obstruction and hydrocephalus, by means of direct mechanical occlusion of ventricular outlets by the cysts or due to an ependymal inflammatory response. Unfortunately, there is little consensus on the optimal management for FVNCC. If possible, surgical removal of cysticerci rather than medical therapy and/or shunt surgery is recommended.9 Endoscopic removal of cysts is described to be an effective treatment modality.5 However, endoscopic removal of inflamed or adherent ventricular cysticerci is associated with increased risk of complications.7 Although microdissection through a posterior fossa telovelar approach is a valid method for FVNCC,2,4 scarce reports describe the therapeutic decision-making and provide a surgical video of adherent FVNCC cyst resection. This operative video shows a 40-year-old female born in Honduras who presented with progressive headache. Computerized tomography revealed ventriculomegaly and transependymal flow. Magnetic resonance imaging (MRI) demonstrated obstructive hydrocephalus secondary to a multiloculated cystic mass within the fourth ventricle. According to the diagnostic criteria, probable racemose FVNCC was suspected.3 MRI raised suspicion that the cysts could be densely adherent to surrounding structures,6 precluding endoscopic removal. We performed a combined microscopic and endoscopic approach, which permitted removal of the cysts through a telovelar approach and hydrodissection technique without damaging nearby structures, and treatment of the associated hydrocephalus through an endoscopic third ventriculostomy (ETV), allowing complete resolution of symptoms and avoidance of CSF shunting.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain 28041.
| | - Guillermo García-Posadas
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain 28041
| | - Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain 28041
| | - Luis Jiménez-Roldán
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain 28041
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Abstract
Neurocysticercosis (NCC) is an important cause of neurological disease worldwide, including imported cases in nonendemic countries. PURPOSE OF REVIEW The purpose of this review is to update information on diagnosis, management, and prevention of neurocysticercosis. RECENT FINDINGS WHO and Infectious Diseases Society of America/American Society of Tropical Medicine and Hygiene guidelines emphasize the importance of corticosteroids and antiparasitic drugs for viable parenchymal disease and single enhancing lesions. Subarachnoid NCC is associated with a high fatality rate unless optimally treated. Advances in subarachnoid NCC include use of prolonged antiparasitic and anti-inflammatory courses and the increasing use of antigen-detection and quantitative PCR assays in diagnosis and follow-up. Emerging data support the safety and efficacy of minimally invasive surgery in ventricular cases. Calcified neurocysticercosis continues to be associated with a high burden of disease. Field studies are demonstrating the feasibility of eradication using a combination of mass chemotherapy for human tapeworms and vaccination/treatment of porcine cysticercosis. SUMMARY NCC remains an important and challenging cause of neurological disease with significant morbidity despite advances in treatment and prevention.
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Trubin PA, Omay SB, Ko AI. Minimally-Invasive Resection of a Racemose Neurocysticercal Cyst. Am J Trop Med Hyg 2022; 107:tpmd220100. [PMID: 35605635 PMCID: PMC9294708 DOI: 10.4269/ajtmh.22-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/11/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Paul Albert Trubin
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Sacit Bulent Omay
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Albert I. Ko
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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Yadav YR, Bajaj J, Ratre S, Yadav N, Parihar V, Swamy N, Kumar A, Hedaoo K, Sinha M. Endoscopic Third Ventriculostomy - A Review. Neurol India 2021; 69:S502-S513. [PMID: 35103009 DOI: 10.4103/0028-3886.332253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Endoscopic third ventriculostomy (ETV) has become a proven modality for treating obstructive and selected cases of communicating hydrocephalus. OBJECTIVE This review aims to summarize the indications, preoperative workup, surgical technique, results, postoperative care, complications, advantages, and limitations of an ETV. MATERIALS AND METHODS A thorough review of PubMed and Google Scholar was performed. This review is based on the relevant articles and authors' experience. RESULTS ETV is indicated in obstructive hydrocephalus and selected cases of communicating hydrocephalus. Studying preoperative imaging is critical, and a detailed assessment of interthalamic adhesions, the thickness of floor, arteries or membranes below the third ventricle floor, and prepontine cistern width is essential. Blunt perforation in a thin floor, while bipolar cautery at low settings and water jet dissection are preferred in a thick floor. The appearance of stoma pulsations and intraoperative ventriculostomography reassure stoma and basal cistern patency. The intraoperative decision for shunt, external ventricular drainage, or Ommaya reservoir can be taken. Magnetic resonance ventriculography and cine phase-contrast magnetic resonance imaging can determine stoma patency. Good postoperative care with repeated cerebrospinal fluid drainage enhances outcomes in selected cases. Though the complications mostly occur in an early postoperative phase, delayed lethal ones may happen. Watching live surgeries, assisting expert surgeons, and practicing on cadavers and models can shorten the learning curve. CONCLUSION ETV is an excellent technique for managing obstructive and selected cases of communicating hydrocephalus. Good case selection, methodical technique, and proper training under experts are vital.
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Affiliation(s)
- Yad Ram Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Jitin Bajaj
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Shailendra Ratre
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Nishtha Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Vijay Parihar
- Department of Neuroradiology, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Narayan Swamy
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Ambuj Kumar
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Ketan Hedaoo
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Mallika Sinha
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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