Endoscopic endonasal surgery for massive subarachnoid neurocysticercosis: illustrative case / Cirugía endoscópica endonasal para neurocisticercosis subaracnoidea masiva: caso ilustrativo

BACKGROUND. Subarachnoid neurocysticercosis (NCC) is associated with high morbidity and mortality rates. Conventional transcranial approaches and transventricular endoscopy have been previously reported for extraparenchymal NCC and ventricular NCC, respectively. By October 2019, endonasal endoscopic approaches had not been used for the treatment of NCC. OBSERVATIONS. A 54-year-old-woman with NCC was admitted with acute neurological deterioration due to severe intracranial hypertension caused by massive subarachnoid NCC cysts, as evidenced on magnetic resonance imaging (MRI) with great brainstem compression. The case was discussed, and an endoscopic endonasal resection of the NCC cysts was scheduled. The diagnosis was confirmed by pathological anatomy. There were no complications in the surgery, with marked neurological improvement. Control MRIs demonstrated a significant reduction of NCC cysts. LESSONS. Minimally invasive approaches are an excellent alternative for skull-base tumoral and infectious pathology. Prior knowledge of the pathophysiology and the authors' experience in the management of patients with NCC allowed them to propose this approach, with optimal results.

FONDO. La neurocisticercosis subaracnoidea (NCC) se asocia a altas tasas de morbilidad y mortalidad. Se han descrito anteriormente abordajes transcraneales convencionales y endoscopia transventricular para la NCC extraparenquimatosa y la NCC ventricular, respectivamente. Hasta octubre de 2019, no se habían utilizado abordajes endoscópicos endonasales para el tratamiento de la NCC. OBSERVACIONES. Una mujer de 54 años con carcinoma de células no pequeñas fue ingresada con deterioro neurológico agudo debido a hipertensión intracraneal grave causada por quistes de carcinoma de células no pequeñas subaracnoideos masivos, evidenciados en la resonancia magnética (RM) con gran compresión del tronco encefálico. Se discutió el caso y se programó una resección endoscópica endonasal de los quistes de carcinoma de células no pequeñas. El diagnóstico se confirmó mediante anatomía patológica. No hubo complicaciones en la cirugía, con una marcada mejoría neurológica. Las RM de control demostraron una reducción significativa de los quistes de carcinoma de células no pequeñas. LeECCIONES. Los abordajes mínimamente invasivos son una excelente alternativa para la patología tumoral e infecciosa de la base del cráneo. El conocimiento previo de la fisiopatología y la experiencia de los autores en el manejo de pacientes con NCC les permitió proponer este abordaje, con óptimos resultados.

Extraparenchymal (Racemose) Neurocysticercosis and Its Multitude Manifestations: A Comprehensive Review

Neurocysticercosis is an infection of the central nervous system caused by the larval form of the pork tapeworm Taenia solium. In the brain it occurs in two forms: parenchymal and extraparenchymal or racemose cysts. The clinical presentation of racemose cysts is pleomorphic, and is quite different from parenchymal cysticercosis. The clinical diagnosis of racemose cysts is quite challenging, with neuroimaging being the mainstay. However, the advent of newer brain imaging modalities has made a more accurate diagnosis possible. The primary focus of this article is racemose neurocysticercosis and its multitude manifestations, and includes a discussion of the newer diagnostic modalities and treatment options.