Endoscopic Transaqueductal Removal of Fourth Ventricular Neurocysticercosis with an angiographic catheter

摘要

OBJECTIVE: Fourth ventrk ular neurocyslicercosis (FVNCC) usually presents with obstruc -live hydrocephalus. Available treatment options are medical, exlernal cerebrospinal fluid diversion, micrnsurgical, or endoscopic. removal alone or in combination. We present our experience: of transaqueduc tal removal of FVNCC by angiographic catheter with endoscopic third venlriculostomy with a rigid endoscope. METHODS: Ten patients (five male and five female patients; age range, 12-4.3 yr; mean, 23.2 vears) with FVNCC with obstructive hydrocephalus underwent endoscopic removal along with endoscopic third ventriculostomv in a single silling, through a frontal pre-coronal burr hole. Diagnosis was established on imaging and confirmed on histology in all of the cases. The Gaab Universal F.ndoscope System along with 4-mm, .H)-degrec rigid telescopes was used to enter the third ventricle, and a cut length of angiographic catheter was negotiated through the aqueduct for removal of FVNCC. RESULTS: Removal of the cyst wasperformed in all cases. A 50-degree rigid telescope provided excellent image quality, with the ability to address intra-FVNCC through the dilated aqueduct with a curved-tip catheter. None of these patients required any further surgery. There were no significant operative or postoperative complications in any of the cases. All of the patients were asymptomatic, with an average follow-up of 18 months. CONCLUSION: Transaqueductal removal of an inlra-fourlh ventricular cyst along with endoscopic third ventriculostomy with a rigid endoscope and catheter is an effective treatment and obviates the need for posterior cranial fossa exploration.