Efficacy and Complications in Neuroendoscopic Management of Intraventricular Neurocysticercosis: A Systematic Review and Meta-analysis

Introduction: Neurocysticercosis (NCC) is an endemic parasitic infection, with intraventricular (IV) cysts causing obstructive hydrocephalus in 10-20% of cases. This study evaluates the efficacy and safety of neuroendoscopic management for IVNCC through a systematic review and meta-analysis.

Methods: Following PRISMA guidelines, a comprehensive search of MEDLINE, Embase, and Lilacs databases was performed for studies published up to September 2024, focusing on the neuroendoscopic management of IVNCC. Eligible studies included at least 5 patients and reported outcomes such as complete cyst resection and complication rates A random-effects model was applied, with heterogeneity assessed through I² and Cochrane Q statistics.

Results: A total of 15 observational studies, including 314 patients with IVNCC, were analyzed. The mean age was 20.64 years, with 168 males. The most common cyst location was the fourth ventricle (138 patients), followed by the third (104) and lateral ventricles (90). Preoperative hydrocephalus was present in 203 cases. The primary intervention was endoscopic resection, often complemented by additional procedures such as ventriculostomy, septostomy, and ventriculoperitoneal shunt placement. The overall rate of complete cyst resection was 90.06%. The overall complication rate was 14.36%, with postoperative seizures being the most common complication (1.61%). Neurological deficits and intraoperative bleeding had minimal risk (0.95% and 0.76%, respectively). Incomplete cyst resection was primarily due to non-visualization (1.64%), and the reoperation rate was 2.96%.

Conclusion : Neuroendoscopic management of IVNCC is effective and safe, achieving high rates of complete cyst resection with low complication rates. While intraoperative bleeding is the leading complication, neurological deficits and postoperative seizures are rare. Adjunctive procedures and anthelmintic drugs significantly enhance outcomes, particularly for third ventricular cysts. These findings support the continued use of neuroendoscopic techniques and highlight the need for further studies with long-term follow-up to improve visualization and resection success in challenging cases.