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Indicações cirúrgicas no tratamento da neurocisticercose
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A neurocisticercose, causa importante de epilepsia nos países em desenvolvimento (onde é endémica), é a doença parasitária mais frequente do sistema nervoso central. É causada pela forma larvar da Taenia solium, e ocorre quando o ser humano se torna hospedeiro intermediário do parasita. As manifestações clínicas variam, de acordo com a localização, número e estádio das lesões. A neuroimagiologia e os testes imunológicos têm um papel fundamental no diagnóstico, mas também na monitorização da resposta à terapêutica. O tratamento é essencialmente médico, mas alguns casos específicos requerem uma abordagem cirúrgica. Esta é recomendada na apresentação extra-parenquimatosa da doença, sendo a neuroendoscopia o procedimento de eleição para a neurocisticercose intraventricular. Está também recomendada para neurocisticercose subaracnoide, espinhal e intraocular. A literatura disponível sobre o tratamento cirúrgico da doença é escassa, sendo maioritariamente baseada em estudos observacionais, dados informais, e opiniões de especialistas. Pretende-se, com este trabalho, sintetizar as indicações cirúrgicas no tratamento da neurocisticercose, bem como analisar os seus resultados e complicações.
Neurocysticercosis, an important cause of epilepsy in the developing countries (where it is endemic), is the most frequent parasitic disease in the central nervous system. It is caused by the larval form of Taenia Solium, and it occurs when the human becomes the intermediate host of the parasite. The clinical manifestations vary according to the location, number and stage of the lesions. Neuroimagiology and the immunological tests have a vital role not only in the diagnosis, but also in the monitoring of the therapeutic response. The treatment is essentially medical, although some specific cases require a surgical approach. This last option is recommended in the extraparenchymal presentation of the disease, neuroendoscopy being the procedure of choice for the intraventricular neurocysticercosis. It its also recommended in the subarachnoid, spinal and intraocular neurocysticercosis. The available literature concerning this disease surgical treatment is scarce and it is majorly based on observational studies, informal data and specialists’ opinions. The present work intends to synthesize the surgical indications in the neurocysticercosis treatment, as well as analyse its results and complications.
Neurocysticercosis, an important cause of epilepsy in the developing countries (where it is endemic), is the most frequent parasitic disease in the central nervous system. It is caused by the larval form of Taenia Solium, and it occurs when the human becomes the intermediate host of the parasite. The clinical manifestations vary according to the location, number and stage of the lesions. Neuroimagiology and the immunological tests have a vital role not only in the diagnosis, but also in the monitoring of the therapeutic response. The treatment is essentially medical, although some specific cases require a surgical approach. This last option is recommended in the extraparenchymal presentation of the disease, neuroendoscopy being the procedure of choice for the intraventricular neurocysticercosis. It its also recommended in the subarachnoid, spinal and intraocular neurocysticercosis. The available literature concerning this disease surgical treatment is scarce and it is majorly based on observational studies, informal data and specialists’ opinions. The present work intends to synthesize the surgical indications in the neurocysticercosis treatment, as well as analyse its results and complications.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Neurocisticercose Taenia solium Cirurgia Hidrocefalia Doenças transmissíveis