DOI: 10.12809/hkmj166073
© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
LETTER TO THE EDITOR
The role of surgery in the management of neurocysticercosis
Megha Dhamne, MD;
Andrew C Hui, FRCP;
Changa Kurukularatne, MD
Department of Medicine, Ng Teng Fong General Hospital, 1 Jurong East
Street 21, Singapore 609606
Corresponding author: Dr Andrew C Hui (andrew_cf_hui@juronghealth.com.sg)
Full
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To the Editor—The report from Ng et al1 is a
timely reminder of the diverse presentation of
neurocysticercosis (NCC), the most prevalent
parasitic disease of the central nervous system and
the most common preventable cause of epilepsy
worldwide.1 2
Recent advances in our understanding of this
disease have guided physicians in the diagnosis of
NCC based on epidemiological, radiological, and
clinical data. This has greatly diminished the role
of diagnostic surgery, typically limited to cases of
atypical solitary cysticercus granuloma. Surgery
for parenchymal NCC is primarily indicated for
large parenchymal colloidal cyst causing mass
effect; intractable epilepsy secondary to NCC and
in practice is mainly ‘restricted to placement of
ventricular shunts for hydrocephalus’.3
Routine evaluation includes relevant
epidemiological information, search for subretinal
parasites by fundoscopic examination and X-rays to
look for calcified cysticerci and serum anticysticercal
antibodies.4 These would usually allow a diagnosis to
be made without craniotomy.
In the case described by Ng et al,1 criteria
for definitive diagnosis had already been fulfilled:
cranial magnetic resonance imaging demonstrated
pathognomonic features of a typical single enhancing
cyst with perilesional oedema and radiographical
evidence of a scolex. The presence of an absolute
diagnostic criterion, supported by clinical and
epidemiological data, would have safely allowed
for empirical medical therapy and observation for
lesion disappearance or reduction with antiparasitic
treatment, perhaps forgoing the need for invasive
neurosurgical procedures and accompanying costs,
complications, and discomfort.5
References
1. Ng EP, Woo PY, Wong AK, Chan KY. Neurocysticercosis in
a young Indian male. Hong Kong Med J 2016;22:399.e1-3. Crossref
2. Garcia HH, Del Brutto OH; Cysticercosis Working Group
in Peru. Neurocysticercosis: updated concepts about an
old disease. Lancet Neurol 2005;4:653-61. Crossref
3. Rajshekhar V. Surgical management of neurocysticercosis.
Int J Surg 2010;8:100-4. Crossref
4. Garcia HH, Evans CA, Nash TE, et al. Current consensus
guidelines for treatment of neurocysticercosis. Clin
Microbiol Rev 2002;15:747-56. Crossref
5. Carpio A, Fleury A, Romo ML, et al. New diagnostic
criteria for neurocysticercosis: Reliability and validity. Ann
Neurol 2016;80:434-42. Crossref