Neuroendoscopic management of intraventricular neurocysticercosis: A systematic review and meta-analysis

Neurocysticercosis is parasitic infection responsible for intraventricular cysts and consequent obstructive hydrocephalus. While the cysts are sometimes treated endoscopically, the efficacy and safety of neuroendoscopic management for intraventricular neurocysticercosis (IVNCC) remains unclear. Therefore, we conducted a systematic review and meta-analysis to evaluate management outcomes of endoscopic IVNCC.

Following PRISMA guidelines, a search of MEDLINE, Embase, and Lilacs databases was performed (inception to September 10, 2024), focusing on the neuroendoscopic management of IVNCC. Eligible studies included at least five patients and reported outcomes of cyst resection and complication rates.

Fifteen studies met our inclusion criteria (n = 314 patients). Mean age at diagnosis was 20.6 years, with 55.6 % (n = 138) patients male, and 44 % (n = 138) of cysts in the fourth ventricle, 32.8 % (n = 104) in the third, and 28.7 % in the lateral ventricles. Preoperative hydrocephalus was observed in 92.3 % (n = 203) of cases. Complete cyst resection was achieved in 90.1 % (n = 214) of patients, with the highest success rates noted in third ventricular cysts (99.6 %; compared to 89.0 % in the lateral and 85.0 % in the fourth ventricles). Flexible endoscopy demonstrated superior outcomes for fourth ventricle cysts (100 %) relative to the rigid endoscope (79.0 %, p < 0.01). Non-visualization of cysts was the primary etiology for incomplete resection (1.6 %). Intraoperative complications included bleeding at 0.76 % (n = 6) and cyst rupture at 0.48 % (n = 5). Postoperative complications involved seizures (1.6 %), neurological deficits (0.95 %), and infection-related mortality (0.85 %). The reintervention rate was 3.0 % (n = 18), with the intervention primarily being cranial shunt implantation. Postoperative anthelmintic therapy significantly improved outcomes from 69.0 % to 96.0 % (p < 0.01).

Neuroendoscopic management of IVNCC is effective and safe. Higher resection rates are achieved with the flexible endoscope, likely secondary to enhanced visualization. Finally, adjuvant postoperative anthelmintic therapy significantly improved outcomes.