Cysticercosis is the most frequent parasitosis of the central nervous system. Often
medical treatment does not influence on ventricular or cisternal cysts or doesn't prevent the
occurrence of complications, such as hydrocephalus. So a considerable grop of patients require
surgical procedures, especially in cases of neural compression or intracranial hypertensio or
epilepsy. Recently stereotactic endoscopic removal of intraaxial small lesions using a
stereotactic guiding tube and a fine endoscope was reported. We tried to control the
symptomatic neurocysticercosis using the stereotactic endoscopic system.
We operated 4 cases of neurocysticercosis. Cerebrospinal fluid(CSF) analysis, enhanced
computerized tomogram(CT) and magnetic resonance image(MRI) scan were performed. There
were no specific findings in CSF analysis. CT and MRI scan showed single intraparenchymal
lesion in 2 cases, one was cystic and the other was solid, multiple intraventricular cysts with
obstructive hydrocephalus in 1 case and mixed type in 1 case. Seizures occured in all
patients, partial sensory type in 3 case who had reciprocal intraparenchymal lesion, generalized
type in 1 case who had obstructive hydrocephalus by multiple ventricular cysts.
For parenchymal lesions, we planned stereotactic open system endoscopic surgery with
variable forceps, laser and suction. Cystic forms were removed successfully but in solid form
additional transgyral microscopic removal was meeded. In intraventricular lesions, we first
placed stereotactic guiding tube via frontal burr hole, then replaced this to 14 Fr peelaway
catheter. Through the peelaway catheter we inserted closed system endoscopy and removed
the cysts with variable forceps and suctions. All intraparenchymal and intraventricular lesions
were removed without specific complications except transient chemical meningitis in one case.
Stereotactic endoscopic surgery make it possible to operate cystic lesions without
degeneration(vesicular stage) wherever they locate.
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