• Jaime Gerardo Torres-Corzo, Mario Alberto Islas-Aguilar, Dominic Shelby Cervantes, and Juan Carlos Chalita-Williams.
• Department of Neurosurgery, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico. Electronic address: torrescjaime@yahoo.com.mx.
• World Neurosurg. 2019 Oct 1; 130: 77-83.

BackgroundNeurocysticercosis, caused by the larval form of the tapeworm Taenia solium, is the most common parasitic disease affecting the human central nervous system. The incidence of spinal neurocysticercosis in endemic regions ranges from 0.25% to 5.85%. Surgery is preferred when medical treatment fails to achieve control of the symptoms or when multiple cysts are present.MethodsWe describe the use of spinal flexible endoscopy for patients with spinal neurocysticercosis who failed to achieve control with standard treatment. Three patients with limb weakness and pain underwent a midline interspinous approach at the L5-S1 level to access the lumbar cistern. The flexible endoscope was introduced, the subarachnoid space was inspected, and the cysticerci were extracted. In 1 patient with cervical subarachnoid blockage, a 3-cm suboccipital craniotomy and removal of the posterior arch of C1 were performed to place a subarachnoid-to-subarachnoid catheter going from the craniocervical junction to the thoracic region.ResultsRemoval of the cysticerci was possible in all cases. No complications related to the surgery were observed. All patients received medical treatment for 2-3 months, and all symptoms were solved.ConclusionsFlexible spinal endoscopy is a feasible and valuable tool in patients with spinal neurocysticercosis that do not respond adequately to standard treatment. It helps restore cerebrospinal fluid dynamics and can be used to place shunt catheters under guided vision. Longer endoscopes are needed to explore the entire spinal subarachnoid space with a single approach, and more research in this area is needed.Copyright © 2019 Elsevier Inc. All rights reserved.

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