Ultrasound-guided resection of cerebellar racemose neurocysticercosis: novel insights from a unique scenario

Racemose neurocysticercosis (RNC) is a malignant form of Taenia solium infection. It carries high mortality due to widespread intraparenchymal invasion, mass effect, and cyst rupture. Cerebellar RNC is unusual and constitutes a surgical challenge. Scarce applications of ultrasound (US) -guided resection have been reported for RNC of the posterior fossa. We report the case of a 66-year-old woman who presented with ataxia and dysmetria. Her past medical history was relevant for seizures and hydrocephalus secondary to neurocysticercosis. Because of the increasing cyst invasion and threatening mass effect in the posterior fossa, the patient underwent US-guided resection of lesions. Postoperative computed tomography (CT) demonstrated complete excision of cysts, and a 2-year follow-up magnetic resonance imaging (MRI) showed no recurrence. On neurological examination, the patient had persistent ataxia without new-onset neurological deficits. The present case study illustrates the feasibility and cost-effective approach of US-guided resection to provide enhanced operative visualization and achieve complete cyst resection.

Racemose Neurocysticercosis: A Rare Cause of Rapidly Progressive Dementia-A Case Report

This report describes the case of a 68-year-old woman with episodic memory impairment for 6 months. Brain magnetic resonance imaging detected multiple extra-axial variable-sized cystic lesions in the left medial temporal lobe, suprasellar cistern, and perimesencephalic cistern. The serum and cerebrospinal fluid tested positive for Taenia solium, confirming racemose neurocysticercosis. Albendazole and praziquantel were administered for 6 months and prednisolone for 1 month. After 3 months, her symptoms resolved. Despite its rarity, racemose neurocysticercosis should be considered in patients with rapidly progressive dementia and cystic brain lesions.

Racemose fourth ventricle neurocysticercosis excision through telovelar approach and hydrodissection

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.

A case of racemose and intraventricular neurocysticercosis in an unusual location

Racemose and intraventricular neurocysticercosis are uncommon types of neurocysticercosis, resulting in a multiloculated, grape-like cluster appearance in the cerebrospinal fluid (CSF) spaces. A male patient presented with symptoms of raised intracranial pressure and demonstrated racemose neurocysticercosis at an atypical location involving the region of the crus of the fornix at the level of the body of lateral ventricles on magnetic resonance imaging. Associated intraventricular neurocysticercosis was seen in the atrium of the left lateral ventricle and fourth ventricle.

Reversible dementia as a presenting manifestation of racemose neurocysticercosis

Racemose cysticercosis is a less frequent presentation of neurocysticercosis (NCC). It's presentation and management is quite different from cerebral parenchymal NCC. Diagnosis of racemose cysticercosis is based on the combination of clinical, epidemiologic, radiographic, and immunologic information. Compared with cysticercus cellulose, which most commonly presents as seizures, racemose NCC due to its extraaxial location presents with raised intracranial pressure and meningitis, and frequently requires neurosurgical intervention. Dementia as a sole presenting feature of NCC is rare. We report a case of racemose NCC with dementia as the presenting manifestation. The outcome of dementia patients with NCC seems favorable in most cases therefore a high index of suspicion for NCC should be kept especially in endemic areas.