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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2024; 43(04): e315-e318
DOI: 10.1055/s-0044-1795073
Review Article

Sellar Neurocysticercosis: A Literature Review

Neurocisticercose Selar: Uma revisão de literatura
Mateus de Sousa Rodrigues 
1   Department of Neurosurgery, Restauração Hospital, Recife, PE, Brasil
,
Camila Maciel Martins Coelho
2   Department of Nursing, Universidade de Pernambuco (UPE), Petrolina, PE, Brasil
,
Camila Rodrigues de Sousa
3   School of Medicine, Estácio-IDOMED, Juazeiro, BA, Brazil
,
Echeley Islany da Silva Oliveira
2   Department of Nursing, Universidade de Pernambuco (UPE), Petrolina, PE, Brasil
,
Atalana Sofia da Silva Sales
4   Department of Pharmacy, Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina, PE, Brasil
,
Renato Bispo de Cerqueira Filho
5   Department of Neurology, Neurocardio Hospital, Petrolina, PE, Brasil
,
Antonio Vinicius Ramalho Leite
6   Department of Neurosurgery, Neurocardio Hospital, Petrolina, PE, Brasil
,
Samuel Miranda de Moura
6   Department of Neurosurgery, Neurocardio Hospital, Petrolina, PE, Brasil
,
José Carlos de Moura
6   Department of Neurosurgery, Neurocardio Hospital, Petrolina, PE, Brasil
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Abstract

The objective of this study was to carry out a literature review on neurocysticercosis. In this sense, a literature review was performed based on articles published on Bireme and Pubmed in the period 2018–2024. The descriptor was used: “intrasellar cysticercosis.” Five studies met the eligibility criteria. Headache was the main symptom observed. The prevalence of the disease by age profile occurred mainly in young adults. The lack of general knowledge and the lack of resources for prevention, diagnosis, and early treatment may be factors that contribute to the persistence of the disease in the population. Furthermore, the lack of resources, such as neuroimaging exams and neurological care, makes it difficult to diagnose and treat the disease; thus, delaying diagnosis contributes to the spread of the infection.


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Resumo

O objetivo deste estudo foi realizar uma revisão de literatura sobre neurocisticercose. Nesse sentido, foi realizada uma revisão de literatura baseada nos artigos publicados na Bireme e Pubmed no período de 2018–2024. Foi utilizado o descritor: “Intrasellar cysticercosis.” Cinco estudos preencheram os critérios de elegibilidade. Cefaleia foi o principal sintoma observado. A prevalência da doença por perfil etário se deu principalmente em adultos jovens. A falta de conhecimento geral e carência de recursos para prevenção, diagnóstico e tratamento precoce podem ser fatores que corroboram para a permanência da doença na população. Ademais, a falta de recursos, como exames de neuroimagem e cuidados neurológicos dificultam o diagnóstico e tratamento da doença, com isso, a demora no diagnóstico contribui para disseminação da infecção.


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Keywords

neurocysticercosis - sellar - intraventricular cyst - racemose - subarachnoid space

Palavras-chaves

neurocisticercose - selar - cisto intraventricular - racemose - espaço subaracnóide

Introduction

Worms are caused by worms that parasitize the host's body. In this context, human cysticercosis is a clinically relevant verminosis with a high incidence, especially in underdeveloped countries.[1] According to the World Health Organization (WHO), Taenia solium is a zoonotic parasite with global distribution but high transmission and is hyperendemic in parts of Latin America, South and Southeast Asia, and sub-Saharan Africa.[2]

The main risk factors for neurocysticercosis are poor environmental conditions, a lack of basic sanitation, and hygienic dietary habits. It is believed that contamination is transmitted via the oral-fecal route, either through food contaminated with parasite eggs or through ingestion of raw or undercooked pork meat.[3] After ingesting T. solium eggs, the cysticerci reach the adult stage in the small intestine. In the muscles, skin, and eyes, the resulting larvae form cysts. In the Central Nervous System (CNS), this same differentiation occurs; however, infection in this system refers to neurocysticercosis.[4]

Patients with neurocysticercosis may present symptoms associated with increased intracranial pressure, seizures, chronic headaches, focal neurological deficits, hydrocephalus, and focal epilepsy.[4] For diagnosis, neuroimaging tests, such as magnetic resonance imaging (MRI) and computed tomography (CT), are considered essential for the diagnosis of neurocysticercosis.[5] [6] Thus, the management of this patient varies according to the severity of the clinical condition, with the use of drug therapy and/or surgical intervention in severe cases.[7]

The present study aims to carry out a literature review on neurocysticercosis.


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Methods

This is a literature review on neurocysticercosis. The databases consulted were Bireme and Pubmed, using the following descriptor: “intrasellar cysticercosis.” The inclusion criteria adopted were: i) studies performed in the last six years (2018–2024); ii) original articles. Studies were excluded: i) literature review. The inclusion criteria were: (i) studies performed in the last six years (2018–2024); (ii) original articles.


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Results

Based on the chosen descriptors, in BIREME, 9 articles were initially identified. However, only 1 article met the eligibility criteria. In the Pubmed database, 30 articles were identified, but only 7 articles met the eligibility criteria. The sum of articles from BIREME and Pubmed totaled 8 articles. After excluding duplicates (n = 1)), 7 articles remained. With the exclusion of non-original articles (n = 2)), 5 articles were selected ([Fig. 1]).

Zoom Image
Fig. 1 Flowchart of selection of literature review citations.

[Table 1] presents the classification of the studies analyzed, according to year, symptoms, affected areas, and therapeutic approaches. It was observed that, in the cases analyzed, all the patients described presented with headaches. However, only a few presented vision impairments at different degrees of progression. Furthermore, 1 of the 4 patients had manifestations related to nausea or dizziness; in the same proportion, a manifestation of subarachnoid or disseminated neurocysticercosis was also observed. Concerning the other affected areas, 2 of the 4 patients presented impaired visual acuity, whether bilateral or not. The approach varied, according to the severity and location affected, that is, there were surgical and/or pharmacological interventions.

Table 1

Characterization of selected studies, second year, symptoms, affected areas and approaches

Author

Yeah

Age

Symptomatology

Affected areas

Approaches

Goulart, et al.[10]

2022

26

Progressive frontal headache, dizziness episodes

Space

subarachnoid

Endonasal endoscopic, medicated:

dexamethasone (12 mg/day) and albendazole (30 mg/kg/day)

Zhang, et al.[12]

2022

20

Headache and nausea

Visual acuity of the left eye of 6/30 and temporal hemianopsia of the left eye

Medication

(Albendazole and Praziquantel))

Shakya, et al.[14]

2021

28

Rapid progressive loss of vision and headache

Visual acuity of the left eye of 6/30 and temporal hemianopsia of the left eye

Medication and pterional craniotomy surgery

Hernandez, et al.[15]

2020

45

Intense chronic headache, progressive deterioration of visual acuity for 6 months and bitemporal hemianopsia

Visual acuity in the right eye 20/60 and in the left eye 20/80 and bitemporal hemianopsia

Surgery

transciliary supraorbital keyhole.

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Discussion

The present study verified the scientific production regarding the time interval between 2018 and 2024 regarding the NCC. Among the 5 selected studies, the following aspects related to the disease were mainly evaluated: clinical manifestations, approach, treatment, and clinical outcome.

According to the results, it was observed that distribution of the infection may occur, affecting neurological and other tissues. This is because the parasite has a tropism for the blood-brain barrier (BBB) and the blood-ocular barrier, which triggers the manifestations of the cases. These manifestations of neurocysticercosis depend on the location where the parasite settles in the human CNS. When the cysts are outside the brain parenchyma (extra parenchymal NCC), they grow and spread, causing conditions related to mass effect, hydrocephalus, chronic arachnoiditis, and vasculitis. Thus, it is the cause of the greatest morbidity and mortality.[8]

Parenchymal cysts rarely grow beyond 2 cm in diameter and establish themselves as small cysts, presenting a more positive prognosis. In this sense, the most common symptoms are headache and seizures, which are commonly of the same type, and their location is related to a parasitic lesion. The occurrence of the manifestations and affected areas described in the literature was observed in the clinical cases of the selected studies.[8]

Neurological symptoms lead patients to seek specialist care, and medical management is defined based on the presentation of symptoms. For symptomatic patients, such as those in the cases described, therapy is based on surgical intervention and/or the use of drugs to minimize symptoms and prevent the development of the parasite.[9]

Before starting treatment with antiparasitic drugs, it is important to establish pharmacological therapy to manage symptoms. The indication of mannitol, steroids, analgesics, and antiepileptics is generally necessary. The use of antiparasitics aims to eliminate cysticerci, although improvement is not immediate. In addition to the possibility of developing inflammation around the lesion, this can lead to the emergence or progression of neurological manifestations. To regulate these unwanted symptoms, the simultaneous administration of steroids is valid.[9]

The NCC of the patient described by Goulart et al.[10] affected the subarachnoid space, the most common site of infection. In these cases, antiparasitic medications are also used to resolve the lesions. Albendazole (ABZ) is the first option due to the drug's potential to reach higher levels in the subarachnoid space.[11]

In the approach chosen in the clinical case of disseminated cysticercosis described by Zhang et al.,[12] a combination of ABZ and praziquantel (PZQ) was chosen. Antiparasitics have different mechanisms of action but are used in combination due to evidence of parasiticidal superiority when compared with monotherapy.[13]

Furthermore, some cases require surgical approaches, among which the most common is the insertion of a ventriculoperitoneal shunt to treat hydrocephalus. Diagnosis and surgery must be performed as soon as possible to minimize the risk of sequelae or death. Others suggest that removing the cysts through surgery is a viable alternative only in situations where the patient has intracranial hypertension. In general, for most patients with neurocysticercosis with giant subarachnoid cysts, surgical procedures, and their potential complications can be avoided.[11]

Therefore, community health and education interventions are important to reduce cases of cysticercosis caused by T. solium, as it is still a neglected disease, according to the WHO. The lack of information regarding the correct hygiene of food and the forms of contamination are the main factors in the spread of the parasite.


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Conclusion

The lack of general knowledge and the lack of resources for prevention, diagnosis, and early treatment may be factors that contribute to the persistence of the disease in the population. Furthermore, the lack of resources, such as neuroimaging exams and neurological care, makes it difficult to diagnose and treat the disease; thus, delaying diagnosis contributes to the spread of the infection.


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Conflict of Interest

None.


Address for correspondence

Mateus de Sousa Rodrigues, Neurosurgery Resident
Neurosurgery Department, Restauração Hospital, Av. Gov.
Agamenon Magalhães, s/n, Derby, Recife, PE, Brazil, Zip Code: 52171-011

Publication History

Received: 10 February 2024

Accepted: 18 October 2024

Article published online:
11 December 2024

© 2024. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Zoom Image
Fig. 1 Flowchart of selection of literature review citations.