Brain parenchyma surgery

Cerebral cysticercosis is the most common brain parasitic disease. Not only in East Asia (China is mainly in North China, Northeast China), South Asia and Latin America and other developing countries, in recent years, with the development of tourism and immigration, the incidence rate in developed countries such as Europe and the United States has also increased, so it has caused countries to the brain cysticercosis The importance of the disease. The central nervous system cerebral cysticercosis accounts for 80% of cysticercosis. The cysticercosis can reside in the brain parenchyma, intraventricular, subarachnoid and other parts, causing clinical symptoms such as epilepsy and increased intracranial pressure. Cerebral cysticercosis is divided into four types: brain parenchyma, ventricle type, subarachnoid type and mixed type. The cysticercosis of the brain is the majority of the cerebral cysticercosis. The cysticercosis resides at the junction of white matter and gray matter, and a few can be diffuse or single-shot in the deep white or subdural. Such cysticercosis is characterized by epileptic seizures. In a few cases, cysticercosis accumulates into clusters, or forms cystic or subdural effusions. CT is the best imaging technique for the diagnosis of cysticercosis in the brain parenchyma. The combination of plain scan and contrast agent enhancement, combined with medical history and serological examination, can be diagnosed before surgery. The CT scan of the single hair cyst is a circular or elliptical low-density area, and the enhanced scan is annularly enhanced with the surrounding edema zone, sometimes with a high-density cephalic section. The number of multiple brain parenchymal cysticercosis varies from several to dozens to hundreds or even more. CT scan showed a multi-nodular low-density shadow, or a slightly high-density lesion, and the enhanced scan was a multi-annular or nodular enhancement. After cysticercosis, the worms are calcified, and CT scans can see multiple punctate calcifications. MRI has a high display rate of brain-stomach cysticercosis. The T1-weighted image has a cystic low signal of 2 to 8 mm in size, and a small dot-like shadow (head section) in the capsule is attached to one side of the capsule wall. The T2-weighted image can be seen in the edema zone around the wall and around, but it is determined that calcification is not as good as CT. Treating diseases: cerebral cysticercosis Indication 1. Diffuse multiple cerebral cysticercosis caused by extensive cerebral edema and increased intracranial pressure, non-surgical treatment is ineffective, endangering the patient's life or vision, may consider craniotomy. 2. Single-ring ring-enhanced lesions are associated with uncontrolled epilepsy, and the lesions are not affected by important neurological functions. Contraindications 1. Diffuse cysticercosis with epilepsy as the main symptom, no significant increase in intracranial pressure, CT shows extensive brain fibrosis. 2. In the acute phase of cysticercosis, the patient has fever and meningeal irritation. CT or MRI suggests extensive cerebral edema. After treatment with dehydrating agents, hormones and anti-parasitic drugs, the symptoms are stable and surgery is not considered. Preoperative preparation If the patient often complains that there are new nodules under the skin, and it has been confirmed as cysticercosis, suggesting that there are aphids in the intestine, it is advisable to first deworming treatment to eliminate the infection of cysticercosis caused by aphids. Surgical procedure Decompression of the diaphragm For diffuse cerebral cysticercosis with severe cerebral edema and increased intracranial pressure, dehydration, corticosteroids and antiparasitic drugs and other non-surgical methods, still can not control cerebral edema and increased intracranial pressure. Decompression of the diaphragm or decompressive external decompression can be performed to save the patient's vision and life. Generally, the right iliac muscle decompression is performed first, and the surgical procedure is as follows. Postoperative intracranial hypertension can be alleviated, otherwise, the other side of the diaphragm under the decompression or decompression of the bone flap. 2. Mass-like placeholder treatment In a small number of patients, brain cysticercosis accumulates into a mass-like mass. If the lesion is not in the functional area, the electrocoagulation cortex and blood vessels around the lesion are cut under the operating microscope, and the granuloma mass and the normal brain tissue are separated by a brain plate and an aspirator. . If the cystic fluid is drained from the cystic lesion, the cysticercosis and the cephalic section should be removed.