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Contemporary Neurosurgical Approaches to Neurocysticercosis

Leonardo Rangel-Castilla, Jose A. Serpa, Shankar P. Gopinath, Edward A. Graviss, Pedro Diaz-Marchan, AND A. Clinton White, Jr^*

Neurocysticercosis (NCC) includes a wide spectrum of illnesses. Newer neurosurgical approaches are being applied to NCC. Although clinical trials are leading to a consensus on medical management, fewer data address neurosurgical approaches. We reviewed all neurocysticercosis patients evaluated by neurosurgery at Ben Taub General Hospital, Houston, Texas, between August 1997 and December 2005. From 31 patients that had a neurosurgical evaluation, 16 patients were treated with shunts (5 had shunt failure requiring revision), 13 by surgical resection of cysts (9 underwent craniotomy and 4 endoscopy), and 2 by medical therapy. A fifth endoscopy was performed in one patient with shunt failure. None of the endoscopic patients needed another intervention. Despite the availability of anti-parasitic and anti-inflammatory therapies, neurosurgery continues to play an important role in the management of selected cases of NCC. In contrast to the high rate of shunt failure, neuroendoscopy seems to be associated with higher success rate than any other neurosurgical approach.

Received August 29, 2008. Accepted for publication November 1, 2008.

^* Address correspondence to A. Clinton White Jr, Department of Infectious Diseases, University of Texas Medical Branch (UTMB), 301 University Boulevard, Galveston, TX 77555-0517. E-mail: acwhite{at}utmb.edu

These authors contributed equally to this manuscript.

Authors’ addresses: Leonardo Rangel-Castilla, Division of Neurosurgery, University of Texas Medical Branch (UTMB), 301 University Blvd., Galveston, TX 77555-0517, Tel: 409-772-8969, Fax: 409-772-1742, E-mail: lerangel{at}utmb.edu. Jose A. Serpa, Department of Medicine, Section of Infectious Disease, Baylor College of Medicine, One Baylor Plaza, Mail stop: BCM286, Tel: 713-798-8918, Fax: 713-798-8948, E-mail: jaserpaa{at}bcm.tmc.edu. Shankar P. Gopinath, Department of Neurosurgery, Baylor College of Medicine, 1709 Dryden, Suite 750, Houston, TX 77030, Tel: 713-798-4696, Fax: 713-798-3739, E-mail: shankarg{at}bcm.tmc.edu. Edward A. Graviss, Department of Pathology, Baylor College of Medicine, One Baylor Plaza, BCM 315, Houston, TX 77030, Tel: 713-798-8097, Fax: 713-798-8895, E-mail: egraviss{at}bcm.tmc.edu. Pedro Diaz-Marchan, Department of Radiology, Baylor College of Medicine, One Baylor Plaza, BCM 360, Houston TX 77030, Tel: 713-793-8689, Fax: 713-798-8050, E-mail: pedrod{at}bcm.tmc.edu.

Reprint requests: A. Clinton White Jr, Department of Infectious Diseases, University of Texas Medical Branch (UTMB) 301 University Blvd., Galveston, TX 77555-0517, E-mail: acwhite{at}utmb.edu.