Endoscopic transaqueductal removal of fourth ventricular neurocysticercosis: Report of three cases

Abstract

In this study, we try to present our experience of transaqueductal removal of the fourth ventricular neurocysticercosis (FVNCC) with a flexible neuroendoscope. Three cases of the fourth ventricular cysticercosis were transaqueductally removed with FUJINON EB-270P flexible neuroendoscope through a frontal precoronal burr hole. The diagnosis was established on imaging and confirmed on histology in all of the cases. Complete excision of cysts in the fourth ventricle was performed in all cases with no significant intraoperative or postoperative complications. The shunt and the string-of-beads multiple cysts in the basal cistern were removed simultaneously through the orificium fistulae of the third ventricle floor with the flexible neuroendoscope. Satisfactory postoperative CSF flow around foramen magnum was detected by cine phase-contrast magnetic resonance imaging. All of the patients were asymptomatic, with an average follow-up of 6 months. The whole ventricular system can be explored easily with electrical flexible neuroendoscope. Endoscopic transaqueductal removal of the fourth ventricular cysticercosis with a flexible neuroendoscope should be recommended as the optimal choice of the disease due to its minimal invasion, fewer complications, shorter length of stay and cheaper treatment costs.