Preparation for Surgery for Neurocysticercosis in Children

Indications for Procedure

• Emergent surgical procedures: Surgery may be required in a considerable number of adult patients but rarely in children with NCC because medication does not prevent complications such as hydrocephalus or the pseudotumoral or encephalitic forms of NCC. Imminent threat of intracranial herniation is rare (1).
• Hydrocephalus: The most frequent cause of intracranial hypertension in NCC. It may be related to mechanical obstruction of the CSF pathways resulting from cysts themselves, inflammatory reaction (ependymitis or arachnoiditis), or both (4,5,33,34).
• CSF diversion: Ventriculoperitoneal shunt placement or other procedures such as placement of an external ventricular drain may be indicated if any emergent condition related to hydrocephalus is present.

Preoperative Orders

• Prophylactic Antibiotics: according to the institution’s protocol.
• Steroids: 0.15 mg/kg of dexamethasone is effective to reduce the incidence of postoperative nausea, vomiting, and pain intensity after surgery (56).
• Diuretics: May be considered in case of hydrocephalus (acetazolamide).

Devices to Be Implanted

• Routine CSF drainage devices:  Shunt systems or external ventricular drain kits

Ancillary/Specialized Equipment

• Operative Microscope: Magnification should be used, especially when separating the cyst from the normal surrounding parenchyma. The surgeon must identify the limits of the cyst and preserve normal tissue.
• Endoscope: Neuroendoscopic assistance may be required, especially for ventricular or cisternal cysts
• Neuronavigation system: May be required to access deeply placed cysts.
• Intraoperative imaging (ultrasound, CAT, MRI): Intraoperative imaging is useful for small or deeply placed cysts. Ultrasound may be preferable for cysts closer to the brain surface.