Analysis of the efficacy of"precise positioning method for sparganum"and"direct reinforcement lesion excision method"in the treatment of epilepsy caused by cerebral sparganosis
Objective To analyze the success rate and postoperative efficacy of surgical treatment for cerebral cysticercosis using the"precise positioning method for sparganum"and the"direct reinforcement lesion resection method"to remove live worms.Methods The clinical data of 26 patients with cerebral sparganosis admitted to the Guangdong Sanjiu Brain Hospital from April 2010 to April 2020 were analyzed retrospectively.The related literature were reviewed.Results Among the patients,23 had epilepsy,and 14 had a history of consuming untreated water or eating wild game,accounting for 53.85％.Serological cysticercus antibody test showed positive IgG in 11 out of 13 patients(84.62％),while cerebrospinal fluid cysticercus antibody tests showed positive results in 6(60.00％)and weak positive results in 2(20.00％).Cranial magnetic resonance imaging(MRI)examinations revealed softening lesions and glial proliferation involving more than 2 cerebral lobes in 22(84.62％).In the"precise positioning method for sparganum"group,all 7 cases had successful single-stage active larvae retrieval.In the"direct reinforcement lesion resection method"group,out of 19 cases,14 had successful single-stage active larvae retrieval(including one patient with retrieval of 2 active larvae).The follow-up period ranged from 2 to 12 years,with an average of(5.04±2.86)years.Engel class Ⅰ outcome was achieved in 20 cases(76.92％).In the successful active larvae retrieval group,Engel class Ⅰ outcome was achieved in 17 cases(85.00％),while in the unsuccessful retrieval group,Engel class Ⅰ outcome was achieved in 3 cases(50％).In the"precise positioning method for sparganum"group,Engel class Ⅰ outcome was achieved in 7 cases(100％),while in the"direct reinforcement lesion resection method"group,Engel Class Ⅰ outcome was achieved in 13 cases(68.42％).All patients did not show significant functional impairment after surgery,and there was no significant difference in the seizure free rate between the two groups(P＞0.05),which may be related to the limited sample size.Conclusions The"precise positioning method for sparganum"enables accurate localization of cerebral sparganosis,improving the success rate of active larvae retrieval and the postoperative seizure-free rate.For cerebral sparganosis located near functional areas,intraoperative awakening,neuronavigation and precise localization through post-processing of three-dimensional images can be used to achieve optimal results by ensuring functionality while removing the active larvae surrounded by granulomas.This method deserves further promotion and application.
cerebral sparganosisprecise positioning method for sparganumneuronavigationintraoperative awakening
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