Systematic Review and Meta-Analysis of Management Strategies and Outcomes in Adult Spinal Neurocysticercosis.

Systematic Review and Meta-Analysis of Management Strategies and Outcomes in Adult Spinal Neurocysticercosis.:

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Systematic Review and Meta-Analysis of Management Strategies and Outcomes in Adult Spinal Neurocysticercosis.

World Neurosurg. 2020 Mar 26;:

Authors: Barrie U, Badejo O, Aoun SG, Adeyemo E, Moler N, Christian ZK, Caruso JP, El Ahmadieh TY, Ban VS, MacAllister MC, Reyes VP, Hall K, Whitworth L, Bagley CA

Abstract

OBJECTIVE: Spinal involvement in neurocysticercosis is rare and can lead to debilitating injury if not diagnosed and treated early. We aimed to provide the reader with a thorough analysis of the best available evidence regarding patient characteristics, optimal treatment modality and outcomes in cases of spinal neurocysticercosis. Methods A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was made according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An illustrative case of intramedullary cervical spinal disease is also presented for illustrative purposes.

RESULTS: A total of 46 reports of 103 patients fitting the screening criteria were identified. Isolated spinal involvement was seen in 46.15% of patients. Most infections (76.92%) had an intradural extramedullary localization with 43.27% of cases involving more than one spinal cord level. The most common presenting symptoms were motor deficits (77.88%), pain syndromes (64.42%), and sensory deficits (53.85%). Combined surgical resection and pharmacologic therapy was the most frequently used treatment modality (49.04%) and had the highest proportion of patients reporting symptomatic improvement at follow up (78.43%). Combination therapy had a significantly higher rate of neurological recovery compared to surgery alone (p=0.004) or medical treatment (p=0.035).

CONCLUSIONS: Spinal involvement in neurocysticercosis should be considered in patients from or who traveled to endemic areas presenting with ring enhancing . lesions. Combined treatment with surgery followed by cysticidal and steroid medication appears to be superior to surgery or medical treatment in isolation and seems to provide the highest chances of recovery.

PMID: 32224269 [PubMed - as supplied by publisher]