Diagnosis and stereotactic aspiration treatment of cerebral sparganosis: summary of 11 cases
Diagnosis and stereotactic aspiration treatment of cerebral sparganosis: summary of 11 cases
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DOI：
10.3171/2010.4.jns1079
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发表时间：
2011-05-01
影响因子：
4.1
通讯作者：
Qian, Suokai
中科院分区：
文献类型：
--
作者：
Deng, Lei;Xiong, Pengju;Qian, Suokai
Object.脑裂头蚴病是一种罕见但被低估的寄生虫病，由裂头蚴感染引起。由于缺乏特征性临床表现，很难在术前作出确诊。一个详细的协议，诊断和治疗脑裂头蚴病仍然缺乏文献。在这篇文章中，作者提出了诊断和治疗脑裂头蚴病的综合程序，描述了立体定向抽吸技术的使用，并根据多个病例的经验进行显微外科手术。回顾性分析11例脑裂头蚴病患者的病史、临床表现、影像学特点及治疗方法。所有11例患者均进行了立体定向抽吸手术，3例患者辅以显微手术。本文总结了这些治疗方法的经验和体会，并对脑裂头蚴病的诊断和治疗方案进行了综述。11例患者均取出曼氏迭宫绦虫幼虫，10例完全切除，1例部分切除（后发现）。术后11例患者临床症状均明显改善。所有癫痫症状均成功治愈，但有1例因幼虫未完全清除而仍发生偶发性癫痫发作。术前有轻偏瘫的4例患者肌力恢复正常。1例患者出现部分身体感觉障碍，术后症状消退。无并发症及死亡。作者得出结论，通过详细询问可能的感染史和疾病症状以及仔细检查特征性放射学特征和免疫学检测结果，可以对脑裂头蚴病进行有效的术前诊断。在立体定向手术切除幼虫，应优先考虑图像引导立体定向抽吸，因为它会导致最小的伤口。在立体定向抽吸失败的情况下，应进行立体定向显微手术以去除幼虫。外科医生必须小心避免打破幼虫和留下任何幼虫残留在手术过程中。(DOI：10.3171/2010.4.JNS1079）
Object. Cerebral sparganosis is a rare but underestimated parasitic disease caused by infestation by sparganum. It is difficult to make a confirmed preoperational diagnosis of this disease given the absence of characteristic clinical manifestations. A detailed protocol for the diagnosis and treatment of cerebral sparganosis is still lacking in the literature. In this article the authors set out comprehensive procedures for the diagnosis and treatment of cerebral sparganosis, describing the use of a stereotactic aspiration technique complemented by microsurgery based on experience gained from multiple cases.Methods. The disease history, clinical manifestations, imaging features, and therapeutic procedures for 11 patients with cerebral sparganosis were retrospectively analyzed. Stereotactic aspiration procedures were performed in all 11 patients and were complemented by microsurgeries in 3 patients. The learning and experience gained from these treatments were summarized, and a comprehensive protocol for the diagnosis and treatment of cerebral sparganosis was reviewed.Results. Larvae of Spirometra mansoni were taken from all 11 patients: completely removed in 10 cases and partially removed in I case (discovered later). After surgery, clinical symptoms in all 11 patients were significantly improved. All epileptic symptoms were successfully cured, although in 1 case occasional seizures still occurred because of the incomplete removal of the larva. Muscle strength in the 4 patients who had hemiparesis prior to surgery recovered to normal. Symptoms in the 1 patient who had presented with partial body sensory disturbance resolved after surgery. There were no complications or deaths.Conclusions. The authors concluded that an effective preoperative diagnosis of cerebral sparganosis can be made by detailed inquiry into the possible infection history and disease symptoms as well as careful scrutiny of characteristic radiological features and immunological testing results. In stereotactic operations performed to remove the larva, priority should be given to image-guided stereotactic aspiration given that it causes the smallest wounds. In cases in which stereotactic aspiration fails, stereotactic microsurgery should be performed to remove the larva. The surgeon must carefully avoid breaking the larva and leaving behind any larva residue during surgery. (DOI : 10.3171/2010.4.JNS1079)