{"paper_id":"216ffd05-ae0c-4902-ad21-c7db800e2d58","body_text":"Efficacy and safety of endoscopic management in intraventricular neurocysticercosis: a systematic review and meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Efficacy and safety of endoscopic management in intraventricular neurocysticercosis: a systematic review and meta-analysis Fritz Fidel Váscones-Román, Omar Gustavo Perez Nestares, Fernando Canazas-Paredes, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8283848/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Intraventricular neurocysticercosis (IVNCC) is a severe form of neurocysticercosis frequently associated with obstructive hydrocephalus and poor response to medical therapy alone. Neuroendoscopic procedures have been increasingly used to remove cysts and treat hydrocephalus, but their efficacy and safety have not been systematically quantified. Objective To assess the efficacy and safety of endoscopic management (EM) in patients with IVNCC. Methods We systematically searched PubMed, Embase, Scopus, Web of Science, SciELO and LILACS from inception to November 2025 for observational studies reporting outcomes of EM in IVNCC. Primary efficacy outcomes were clinical improvement and cure (no cysts on imaging and no symptoms) at last follow-up. Safety outcomes included perioperative complications, ventriculoperitoneal shunt (VPS) placement and mortality. Random-effects meta-analyses of proportions and odds ratios were performed. Results We included 21 studies comprising 439 patients with IVNCC, of whom 384 underwent EM. The pooled proportion of patients with clinical improvement was 0.99 (95% CI 0.87–1.00), and the pooled cure rate was 0.97 (95% CI 0.76–1.00). The pooled proportions were 0.06 (95% CI 0.03–0.14) for VPS placement, 0.10 (95% CI 0.05–0.19) for perioperative complications and 0.01 (95% CI 0.01–0.04) for perioperative mortality. In three comparative studies, there was no statistically significant difference between EM and conventional surgical approaches in terms of VPS requirement (odds ratio 0.32, 95% CI 0.03–3.59). Overall, the certainty of evidence was low due to the observational design and risk of bias. Conclusions Endoscopic management for IVNCC is associated with very high rates of clinical improvement and cure, a low need for VPS and low perioperative mortality, supporting its use as a first-line option in appropriately selected patients. However, the current evidence is based on observational studies with important limitations; prospective comparative studies are needed to better define the role of EM versus conventional surgery. Neurocysticercosis Endoscopic management Efficacy Safety Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Neurocysticercosis (NCC) is a neglected disease with a significant global burden, especially in endemic regions such as Latin America, sub-Saharan Africa, and Southeast Asia [ 1 ]. Intraventricular NCC, a severe subtype, accounts for 7.3% to 61.3% of NCC cases reported in the literature and is often associated with hydrocephalus, cerebrospinal fluid (CSF) obstruction, and increased morbidity and mortality due to its poor response to medical therapy alone [ 2 ]. These challenges underscore the need for specialized interventions, taking into account parasite location, number, and viability, with various treatment options extending beyond antiparasitic therapy. The advent of neuroendoscopic techniques has expanded treatment possibilities, positioning endoscopic ventriculostomy as a preferred approach in modern practice. In addition to diagnostic benefits from direct visualization, endoscopic management (EM) allows for cyst removal with minimal impact on surrounding brain parenchyma [ 3 , 4 ]. EM has been shown to be effective in reducing the need for ventriculoperitoneal shunting, avoiding complications related to shunt dependence, and managing hydrocephalus through procedures like endoscopic third ventriculostomy (ETV) [ 5 ]. Moreover, EM offers the advantage of preventing ependymitis caused by degenerating cysticerci, which can otherwise lead to CSF obstruction [ 6 ]. Given these advantages, endoscopic cyst retrieval has gained traction as a viable alternative to traditional surgery. However, despite its growing use, robust evidence on the long-term efficacy and safety of EM in intraventricular NCC remains limited. Thus, our objective is to systematically assess the efficacy and safety of endoscopic management in intraventricular neurocysticercosis, addressing gaps in current clinical practice and informing future treatment guidelines. To date, only a few systematic reviews have specifically addressed intraventricular NCC, and most have focused either on anatomic subgroups or on technical aspects rather than patient-centred outcomes. Milenković et al. summarized lateral ventricle neurocysticercosis based primarily on case reports and small series, without performing a formal quantitative synthesis of clinical endpoints [ 10 ]. More recently, Mendieta-Barrera et al. conducted a systematic review and meta-analysis of neuroendoscopic management in IVNCC, emphasizing extent of resection, technical nuances and reintervention rates [ 15 ]. However, they did not comprehensively pool key clinical outcomes such as overall clinical improvement, cure, shunt dependence and perioperative mortality across all available series, nor did they quantitatively compare endoscopic versus conventional surgery. Building on and extending this work, the present study aims to provide an updated, patient-centred synthesis of endoscopic management for IVNCC, incorporating a larger sample of patients, formal meta-analyses of core clinical outcomes, and exploratory comparisons with conventional surgical approaches. Methods This systematic review and meta-analysis was registered in PROSPERO (CRD420251241194) and conducted in accordance with the PRISMA 2020 statement [ 7 ]. We performed a comprehensive search of PubMed, Embase, Scopus, Web of Science, SciELO and LILACS from inception to November 2025. The search combined keywords and MeSH terms related to “neurocysticercosis”, “intraventricular neurocysticercosis”, “ventricular cysticercosis”, “endoscopic surgery” and “neuroendoscopy”, and was adapted to each database (Supplementary Table S1 ). No restrictions were applied on publication date; studies published in English or Spanish and conducted in humans were eligible. Reference lists of relevant articles and reviews were also screened to identify additional studies. Studies were included if they (1) involved patients with a diagnosis of intraventricular neurocysticercosis; (2) reported the use of endoscopic management (EM) as part of the treatment (with or without concomitant procedures such as endoscopic third ventriculostomy); and (3) provided data on at least one outcome of interest (clinical improvement, cure, complications, ventriculoperitoneal shunt [VPS] placement or mortality). We excluded case reports, narrative reviews, editorials, conference abstracts, purely parenchymal or subarachnoid forms without intraventricular involvement, and studies focused exclusively on medical therapy without surgical intervention. Only original observational studies (case series or cohort studies) were considered. Two reviewers independently screened titles and abstracts, followed by full-text assessment of potentially eligible articles. Disagreements at any stage were resolved by discussion or, when necessary, consultation with a third reviewer. The study selection process is summarized in a PRISMA flow diagram (Figure S1 ). Using a standardized extraction form, two reviewers independently collected data on first author, year of publication, country, study design, sample size, patient demographics, cyst location, endoscopic approach and associated procedures (e.g. EM + ETV), use of adjunctive medical therapy when reported, and follow-up duration. For efficacy outcomes, we extracted the number of patients with clinical improvement and those considered cured (no cysts on imaging and no symptoms at last follow-up). For safety outcomes, we recorded the number of patients requiring VPS, experiencing at least one perioperative complication, and dying in the perioperative period. When necessary, authors’ definitions of outcomes were harmonised to fit these categories, and discrepancies in extracted data were resolved by consensus. Because all included studies were observational, risk of bias was evaluated at the study level using domains adapted from ROBINS-I for non-randomised studies [ 8 ]. We assessed selection of participants, deviations from intended interventions, completeness of outcome data, outcome measurement and selective reporting, and classified each study as having low, moderate or serious risk of bias; disagreements were resolved by discussion. We performed meta-analyses of proportions for clinical improvement, cure, VPS placement, perioperative complications and perioperative mortality among patients treated with EM. For comparative studies, we pooled odds ratios (ORs) for VPS requirement in EM versus conventional surgery. Random-effects models were used throughout to account for between-study heterogeneity. Proportions were analysed using logit transformation to stabilise variances; for ORs, standard random-effects models were applied. Statistical heterogeneity was quantified using the I² statistic and τ², considering I² values of 25%, 50% and 75% as low, moderate and high heterogeneity, respectively. Where appropriate, 95% prediction intervals were calculated to estimate the expected range of effects in future settings. All analyses were conducted using R (R Foundation for Statistical Computing, Vienna, Austria) with the meta and metafor packages. Results Study selection and characteristics From 1447 records identified through the database search, 21 studies met the inclusion criteria, contributing a total of 439 patients with intraventricular NCC (Figure S1 ). All studies were observational (case series or retrospective cohorts); several included a comparative group treated with conventional surgery or medical therapy. Overall, 384 patients underwent endoscopic management (EM), with or without concomitant steroid therapy. Endoscopic approaches included transcortical, transforaminal, transaqueductal, transventricular and transcallosal routes. Cysts were located in the lateral ventricles in 79 patients, the third ventricle in 63, the fourth ventricle in 180 and other sites (such as the aqueduct of Sylvius or basal cisterns) in 6 patients; several patients harboured cysts in more than one ventricle. Among those treated endoscopically, 163 underwent endoscopic cyst removal only, while others had endoscopic third ventriculostomy or combined procedures. Not all studies reported the same outcomes. Across studies that provided data, 214 patients had information on clinical improvement, 152 on cure, 412 on VPS placement, 356 on perioperative mortality and 401 on perioperative complications. The main characteristics of the included studies are summarized in Table 1 . Table 1 Included studies with extracted variables. Author, year Country Study design IVNCC patients, n Endoscopic management, n Endoscopic cyst removal only, n Endoscopic approach* Cyst location† Clinical improvement, n/N Cure, n/N Complications, n/N Mortality, n/N Apuzzo M, 1984 [ 19 ] USA Case Series 45 1 0 Transcallosal Lateral: 5 III: 12 IV: 24 Aqueduct of Sylvius: 4 NR NR 0 0 Bergsneider M, 1999 [20] USA Case Series 5 5 0 Transforaminal IV: 5 5 3 1 NR Bergsneider M, 2000 [ 21 ] USA Case Series 10 10 10 Transcortical (precoronal frontal) Lateral: 6 III: 4 10 7 2 NR Anandh B, 2001 [22] India Case Series 9 9 0 Transcortical, transaqueductal Lateral: 4 III: 1 IV: 3 Lateral + III: 1 9 NR 3 0 Torres-Corzo J, 2006 [23] Mexico Case Series 7 7 0 Transforaminal, transaqueductal, frontal precoronal III: 7 7 7 0 0 Husain M 2007, [24] India Case Series 10 10 0 Transcortical (precoronal frontal) IV: 10 10 10 0 0 Husain M, 2007 [25] India Case Series 21 21 0 Transcortical, transaqueductal Lateral: 6 III: 6 IV: 10 21 21 0 0 Suri A, 2008 [26] India Case Series 6 6 0 Transcortical, transforaminal Lateral: 1 IV: 5 6 NR 0 0 Goel A, 2008 [ 27 ] India Case Series 22 22 1 Transcortical, transaqueductal Lateral: 4 III: 3 IV: 14 Lateral + III: 1 22 NR 2 0 Jimenez-Vazquez O, 2008 [28] Mexico Case Series 9 9 9 NR NR NR NR NR NR Kumar A, 2008 [29] India Case Series 11 1 1 Transcallosal Lateral: 4 IV: 4 Foramen of monro: 2 Aqueduct: 1 NR NR 0 0 Rangel-Castilla L, 2009 [30] USA Retrospective observational study 19 4 2 NR 4 NR 0 0 Torres-Corzo J, 2010 [31] Mexico Cohort 86 86 0 Transcortical Lateral: 6 III: 6 IV: 20 Subarachnoid space:24 Cerebral aqueduct: 1 NR NR 8 3 Ranjan S, 2014 [ 32 ] India Retrospective observational study 21 17 17 Transventricular, transforaminal, transaqueductal IV: 21 17 14 2 0 Zhenye L, 2017 [33] China Retrospective observational study 21 21 21 Transcortical Solitary NCC: 4 2 or more NCC: 17 18 NR 8 1 Nash TE, 2018 [34] USA Retrospective review 23 3 NR NR Lateral 11 III: 2 IV: 16 Aqueduct 1 NR NR 2 0 Sharma BS,2019 [35] India Case Series 5 5 0 Transcortical, transforaminal, transaqueductal IV: 4 5 5 0 0 Kaif M, 2018 [36] India Case Series 30 30 0 Transcortical, Transaqueductal, Transforaminal Lateral: 1 III: 16 IV: 12 Septum Cavum: 1 NR NR 3 NR Singh G, 2019 [37] India Case Series 12 12 12 Transforaminal, transaqueductal Lateral: 3 III: 1 IV: 7 Lateral + III: 1 NR NR 5 0 Konar S, 2020 [38] India Case Series 61 61 0 Transventricular, trans foraminal, trans aqueductal Lateral: 18 III: 9 IV: 34 NR NR 3 1 Aggarwal VK, 2020 [39] India Retrospective observational study 26 26 0 Transcortical, transqueductal Lateral: 4 III: 14 IV: 8 26 26 5 0 Xu et al., 2025 [40] China Retrospective observational study 51 51 51 Transventricular, transforaminal, tranaqueductal Lateral: 8 III:2 IV:2 Basal subaracnoideo cistern: 1 ≥ 2 locations: 38 51 50 7 0 *Endoscopic approach as reported by the authors (e.g. transcortical, transforaminal, transaqueductal, transventricular, transcallosal). †Number of patients with cysts in each ventricular compartment: LV, lateral ventricle; III, third ventricle; IV, fourth ventricle; Aq, aqueduct of Sylvius; “≥2 ventricles” indicates patients with cysts in more than one ventricular location. Abbreviations: IVNCC, intraventricular neurocysticercosis; EM, endoscopic management; LV, lateral ventricle; VPS, ventriculoperitoneal shunt; NR, not reported. Efficacy outcomes Clinical improvement Fourteen studies reported clinical improvement after EM, encompassing 214 patients, of whom 210 improved clinically. The pooled proportion of patients with clinical improvement was 0.99 (95% CI 0.87–1.00) under a random-effects model, corresponding to an estimated 99% improvement rate (Fig. 1 ). Statistical heterogeneity was negligible (I² = 0%), indicating consistent results across studies. Cure Nine studies (152 patients) reported cure, defined as absence of cysts on imaging and no symptoms at last follow-up; 143 patients met this criterion. The pooled cure proportion was 0.97 (95% CI 0.76–1.00) with a random-effects model, i.e. an estimated 97% cure rate (Fig. 2 ). Heterogeneity was very low (I² = 0.4%), suggesting that cure rates were highly consistent among studies. Safety outcomes Ventriculoperitoneal shunt (VPS) requirement Nineteen studies reported VPS placement in 412 patients treated endoscopically; 35 required a VPS during follow-up. The pooled proportion of patients needing a VPS after EM was 0.06 (95% CI 0.03–0.14) using a random-effects model, corresponding to an estimated 6% VPS rate (Fig. 3 ). Heterogeneity was low (I² = 15.4%), indicating relatively modest variability in shunt requirement among studies. Perioperative mortality Sixteen studies (356 patients) reported perioperative mortality, with 5 deaths observed. The pooled mortality proportion was 0.01 (95% CI 0.01–0.04) under a random-effects model, i.e. an estimated 1% perioperative mortality rate (Fig. 4 ). There was no statistical heterogeneity (I² = 0%), reflecting highly consistent mortality estimates. Perioperative complications Nineteen studies with 401 patients provided data on perioperative complications; 44 patients experienced at least one complication. The pooled complication proportion was 0.10 (95% CI 0.05–0.19), corresponding to an estimated 10% complication rate after EM (Fig. 5 ). Heterogeneity was moderate (I² = 33.1%), suggesting some variability in reported complication rates, likely due to differences in surgical technique, complication definitions and reporting across studies. Comparison between endoscopic management and conventional surgery Three studies directly compared EM with conventional surgical approaches for intraventricular NCC in terms of VPS requirement. The random-effects meta-analysis showed no statistically significant difference between EM and conventional surgery (odds ratio 0.32, 95% CI 0.03–3.59, I² = 0%; Fig. 6 ). Although the point estimate favoured EM (lower odds of VPS), the wide confidence interval reflects the small number of comparative studies and limited statistical power. Risk of bias All included studies were observational and generally judged at moderate to serious risk of bias, mainly due to non-consecutive patient inclusion, lack of control groups, heterogeneous and sometimes poorly defined outcome measures, and incomplete reporting of follow-up. These limitations reduce the overall certainty of the evidence and should be considered when interpreting the pooled estimates (Figure S2). Discussion In this systematic review and meta-analysis of 21 observational studies including 439 patients with intraventricular neurocysticercosis (IVNCC), we found that neuroendoscopic management is associated with excellent clinical outcomes and an acceptable safety profile. Pooled proportions showed that 99% of patients improved clinically and 97% achieved cure at last follow-up, while only 6% required a ventriculoperitoneal shunt (VPS), 10% experienced perioperative complications and 1% died. These findings support endoscopic management (EM) as a first-line strategy for appropriately selected patients with IVNCC, particularly those with obstructive hydrocephalus and cysts in surgically accessible ventricular locations, in line with contemporary guidelines that advocate surgical removal of ventricular cysts whenever feasible [ 2 , 4 , 11 , 15 ]. Our findings also add important incremental value to the existing body of literature on IVNCC. Milenković et al. provided a comprehensive qualitative synthesis of lateral ventricle neurocysticercosis but did not perform a quantitative meta-analysis of outcomes and largely restricted their scope to a single ventricular compartment [ 10 ]. Mendieta-Barrera et al. subsequently reported a systematic review and meta-analysis of neuroendoscopic management in IVNCC, focusing on complete cyst resection rates, reintervention and selected complications in 314 patients [ 15 ]. In contrast, our work pools data from 439 patients across all ventricular locations and centres its analyses on clinically meaningful endpoints—global clinical improvement, cure, shunt dependence, perioperative complications and mortality—thereby offering a more direct estimate of the real-world benefit–risk profile of endoscopic management. Moreover, by incorporating the limited comparative data available, we provide the first quantitative synthesis of ventriculoperitoneal shunt requirement in endoscopic versus conventional surgical approaches, while explicitly framing our conclusions within a health-systems and global neurosurgery perspective. Taken together, these features position our study as a complementary and patient-focused update to prior technical and anatomically oriented reviews [ 10 , 15 ]. Comparison with previous literature Our results are consistent with and extend the findings of prior single-centre series that established neuroendoscopy as an effective option for IVNCC. Bergsneider et al. reported high rates of symptom resolution and cyst removal using endoscopic approaches to the lateral and third ventricles, with most patients avoiding permanent shunting [ 12 ]. Husain et al. similarly demonstrated restoration of CSF flow and excellent functional outcomes following neuroendoscopic surgery, even when cysts could only be partially removed [ 13 ]. Subsequent series from Mexico and India, among others, confirmed that endoscopic cystectomy combined with endoscopic third ventriculostomy (ETV) could effectively treat hydrocephalus while minimizing brain manipulation and postoperative morbidity [ 4 – 6 , 14 ]. Our pooled cure rate of 97%, derived from a larger and more diverse sample, quantitatively reinforces these observations and suggests that durable cyst eradication is achievable in the vast majority of endoscopically treated patients. A recent systematic review and meta-analysis by Mendieta-Barrera et al. focused specifically on neuroendoscopic management of IVNCC and reported complete cyst resection in 90% of 314 patients, with reintervention in only 3% and very low rates of serious complications [ 15 ]. That study primarily emphasized technical aspects—such as the superiority of flexible over rigid endoscopes for fourth-ventricle cysts and the potential benefits of postoperative anthelmintic therapy—rather than systematically quantifying patient-centred outcomes. Our work complements and expands this evidence by pooling clinically meaningful endpoints (cure, overall clinical improvement, VPS dependence and mortality) across 439 patients, including additional recent series. Together, both meta-analyses converge on the message that neuroendoscopic surgery is highly effective and safe for IVNCC when performed in experienced centres, while our study further clarifies its clinical impact at the patient and health-system levels [ 4 , 10 , 15 ]. Reduction in shunt dependence One of the most clinically relevant findings of our study is the low pooled VPS requirement of 6% after EM. Historically, many patients with IVNCC were treated primarily with CSF shunting, often without cyst removal, particularly where microsurgical or endoscopic expertise was limited [ 2 , 4 , 10 ]. However, VPS is associated with substantial long-term failure rates: in pediatric and young adult hydrocephalus cohorts, 30–40% of shunts malfunction within the first year and approximately 50% by two years, with many patients requiring multiple revisions over their lifetime [ 16 , 17 ]. Shunt infection alone has been reported in 5–12% of cases and markedly increases morbidity and mortality [ 16 , 17 ]. Against this background, the ability of EM to relieve obstruction and control hydrocephalus while avoiding permanent shunt placement in ~ 94% of patients is notable. Even in those who eventually required a VPS, endoscopic debulking and ETV may still reduce shunt dependency and simplify subsequent management [ 3 – 6 , 12 – 14 ]. These findings support current international guidelines, which recommend endoscopic removal of ventricular cysts, with or without ETV, as the preferred strategy and discourage shunt-only approaches whenever technically feasible [ 11 ]. Safety profile of neuroendoscopic surgery We observed a pooled perioperative complication rate of 10% and a mortality rate of 1%, with no between-study heterogeneity for mortality. Reported complications included transient neurological deficits, intraoperative bleeding, cyst rupture, CSF leak and infection; most were self-limited or manageable with standard neurosurgical care. These rates compare favourably with those reported for open microsurgical approaches to IVNCC and for VPS surgery in general hydrocephalus populations, where overall complication and failure rates often exceed 20–30% [ 3 , 4 , 10 , 16 , 17 ]. Our results also align with Mendieta-Barrera et al., who found low rates of intraoperative bleeding (0.8%), cyst rupture (0.5%) and infection-related mortality (0.9%) after neuroendoscopic procedures [ 15 ]. The slightly higher overall complication rate in our pooled analysis likely reflects broader definitions of complications and inclusion of heterogeneous observational series with variable reporting quality. Nonetheless, the combination of very high cure and improvement rates with low mortality suggests that, in experienced hands, the benefit–risk profile of EM for IVNCC is favourable. Endoscopy versus conventional surgery In the three comparative studies included, EM did not show a statistically significant advantage over conventional microsurgical approaches regarding VPS requirement (OR 0.32, 95% CI 0.03–3.59). This lack of statistical significance should be interpreted cautiously. First, the small number of comparative studies and patients yields wide confidence intervals and limited power to detect differences. Second, selection bias is likely: endoscopy may have been preferentially offered to cases with more favourable anatomy (e.g. single cysts in accessible locations), whereas more complex lesions or those with dense adhesions were directed to open surgery [ 4 , 10 , 15 ]. Third, outcomes such as length of stay, recovery time, quality of life and cost—which may favour minimally invasive approaches—were rarely reported. Despite these limitations, the available evidence suggests that EM achieves at least comparable, and possibly superior, outcomes to conventional craniotomy for many patients with IVNCC, while offering theoretical advantages in terms of reduced tissue trauma, better visualization of ventricular anatomy and the possibility of combined ETV [ 3 – 6 , 11 – 15 ]. Future prospective comparative studies should stratify patients by ventricular location, cyst burden, and presence of basal subarachnoid disease, and should incorporate patient-centred outcomes such as quality of life, time to functional recovery and health-care costs, to more precisely define which subgroups derive the greatest benefit from an endoscopic versus open approach. Role of adjunctive medical therapy and technical considerations The optimal integration of antiparasitic drugs and corticosteroids with EM remains uncertain. The 2017 IDSA/ASTMH guidelines recommend surgical removal of ventricular cysts as first-line therapy, with cautious use of perioperative corticosteroids to limit inflammatory responses and selective use of albendazole or praziquantel depending on the presence of parenchymal or subarachnoid disease [ 11 ]. Mendieta-Barrera et al. reported that postoperative anthelmintic therapy significantly improved outcomes, from 69% to 96%, in patients undergoing neuroendoscopic cyst removal [ 15 ]. However, few of the primary studies in our meta-analysis provided sufficient detail to evaluate the independent contribution of antiparasitic therapy to long-term outcomes. Similarly, technical variables such as the use of flexible versus rigid endoscopes, the performance of concurrent ETV, and strategies to manage adherent or multiple cysts could not be systematically analysed. Existing series suggest that flexible endoscopes improve access to fourth-ventricle cysts and may increase complete resection rates [ 4 , 14 ], whereas ETV may reduce subsequent shunt dependence, particularly in patients with aqueductal obstruction or fourth-ventricle outlet obstruction [ 3 – 5 , 12 , 13 ]. Prospective registries that systematically capture these technical details, as well as standardized outcome measures, are needed to refine surgical decision-making [ 4 , 10 , 15 ]. Clinical and global health implications IVNCC occurs predominantly in low- and middle-income countries where Taenia solium is endemic and access to advanced neurosurgical care is limited [ 1 , 2 , 18 ]. The high cure and low shunt-dependence rates associated with EM have important implications for health systems with constrained resources. Shunt complications and repeated revisions are costly, require specialized care and may be catastrophic for patients living far from neurosurgical centres [ 16 , 17 ]. Investment in basic neuroendoscopic infrastructure and training in endemic regions could therefore yield disproportionate benefits by reducing long-term morbidity and healthcare utilization. At the same time, implementation must be accompanied by robust perioperative protocols and follow-up systems to ensure patient safety and maintain surgical quality [ 3 – 6 , 11 , 15 , 18 ]. Limitations This review has several limitations. First, all included studies were observational case series or retrospective cohorts, often with small sample sizes, incomplete follow-up and heterogeneous reporting; as a result, the overall certainty of evidence is low. Second, there was variability in the definitions of “cure”, “clinical improvement” and “complication”, as well as in the timing of outcome assessment, which may have introduced misclassification and contributed to residual heterogeneity. Third, most series originated from high-volume referral centres in a limited number of countries, potentially limiting generalizability to lower-volume or resource-constrained settings. Fourth, publication bias is possible, as unsuccessful or highly complicated cases are less likely to be reported. Finally, our ability to perform meaningful subgroup analyses (e.g. by ventricular location, extent of cyst burden, type of endoscope, use of ETV or adjuvant therapy) was limited by incomplete data. Future directions Future research should prioritize prospective, multicentre registries of IVNCC that use standardized diagnostic criteria,[ 2 , 11 ] uniform definitions of outcomes and complications, and long-term follow-up to capture recurrence, shunt failure and quality of life. Pragmatic comparative studies or carefully designed observational cohorts with robust adjustment for confounders are needed to clarify the relative benefits of EM versus microsurgical resection and to define indications for each technique.[ 4 , 10 , 11 , 15 ] In parallel, studies evaluating the incremental value of flexible endoscopes, intraoperative neuronavigation, and postoperative antiparasitic therapy could further optimize treatment algorithms.[ 4 , 11 , 14 , 15 ] Given the concentration of IVNCC in low-resource settings, partnerships between endemic-country centres and high-income institutions will be essential to build capacity, generate high-quality data and ensure that advances in endoscopic technology translate into real-world improvements in patient outcomes. Conclusion Intraventricular neurocysticercosis is a severe form of NCC that is frequently complicated by obstructive hydrocephalus and historically managed with CSF shunting alone. In this systematic review and meta-analysis of 21 observational studies, endoscopic management was associated with very high rates of clinical improvement and cure, a low need for ventriculoperitoneal shunting and low perioperative mortality, supporting its role as a first-line therapeutic option for appropriately selected patients with IVNCC. These findings are consistent across centres and align with current guideline recommendations favouring surgical removal of ventricular cysts whenever feasible. Nevertheless, the available evidence is limited by the observational nature of the included studies, heterogeneous reporting and potential selection bias, resulting in low overall certainty of evidence. Prospective, multicentre cohorts and comparative studies that incorporate standardized outcome definitions, longer-term follow-up and patient-centred endpoints are needed to better define the relative benefits of endoscopic versus open approaches, the role of adjunctive medical therapy and the optimal management of complex or recurrent disease. Expanding access to safe neuroendoscopic surgery in endemic, resource-limited settings should be a parallel priority, given the potential of this strategy to reduce shunt dependence, long-term morbidity and health-care burden in this vulnerable patient population. Declarations Disclosures: The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Clinical trial number: Not applicable Ethics approval and consent to participate declarations: Not applicable Consent for publication: Not applicable. Clinical trial registration: Clinical trial number: Not applicable. Competing interests: The authors declare that they have no competing interests. Funding: No external funding was received for this study. Author Contribution FFVR, KAO and NPB conceived and designed the study. FFVR, OGPN, FCP, DCSF, LAQG, WRG, DVR, DFZS and KAO performed the literature search, study selection and data extraction. FFVR, OGPN, FCP and NPB conducted the statistical analyses and prepared the figures and tables. HSP, WM and NPB provided clinical and methodological oversight and contributed to the interpretation of the results. FFVR drafted the first version of the manuscript. All authors critically revised the manuscript for important intellectual content, approved the final version of the article, and agree to be accountable for all aspects of the work. References Bouteille B (2014) Épidémiologie de la cysticercose et de la neurocysticercose [Epidemiology of cysticercosis and neurocysticercosis]. 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Neurosurg Focus 6(4):e7 Husain M, Jha DK, Rastogi M, Husain N, Gupta RK (2007) Neuro-endoscopic management of intraventricular neurocysticercosis (NCC). Acta Neurochir (Wien) 149(4):341–346. 10.1007/s00701-006-1059-z Kaif M, Husain M, Ojha BK (2019) Endoscopic Management of Intraventricular Neurocysticercosis. Turk Neurosurg 29(1):59–65. 10.5137/1019-5149.JTN.21389-17.3 Mendieta-Barrera CD, Punukollu A, Rios-Hurtado C, De Nigris Vasconcellos F, Garcia-Torrico F, Salolin-Vargas VP, Mamani-Julian K, Valderrama CEV, Rivera-Hurtado L, Ballesteros-Herrera D, Tripathi M, Torres-Corzo JG, Ghaffari-Rafi A (2025) Neuroendoscopic management of intraventricular neurocysticercosis: A systematic review and meta-analysis. Clin Neurol Neurosurg 254:108953. 10.1016/j.clineuro.2025.108953 Paff M, Alexandru-Abrams D, Muhonen M, Loudon W (2018) Ventriculoperitoneal shunt complications: a review. Interdiscip Neurosurg 13:66–70. 10.1016/j.inat.2018.04.004 Javeed F, Mohan A, Wara UU, Rehman L, Khan M (2023) Ventriculoperitoneal Shunt Surgery for Hydrocephalus: One of the Common Neurosurgical Procedures and Its Related Problems. Cureus 15(2):e35002. 10.7759/cureus.35002 Nash TE, Mahanty S, Garcia HH (2013) Neurocysticercosis-more than a neglected disease. PLoS Negl Trop Dis. ;7(4):e1964. 10.1371/journal.pntd.0001964 Apuzzo ML, Dobkin WR, Zee CS, Chan JC, Giannotta SL, Weiss MH (1984) Surgical considerations in treatment of intraventricular cysticercosis: analysis of 45 cases. J Neurosurg 60(2):400–407. 10.3171/jns.1984.60.2.0400 Bergsneider M (1999) Endoscopic removal of cysticercal cysts within the fourth ventricle: technical note. J Neurosurg 91(2):340–345. 10.3171/jns.1999.91.2.0340 Bergsneider M, Holly LT, Lee JH, King WA, Frazee JG (2000) Endoscopic management of cysticercal cysts within the lateral and third ventricles. J Neurosurg 92(1):14–23. 10.3171/jns.2000.92.1.0014 Anandh B, Mohanty A, Sampath S, Praharaj SS, Kolluri S (2001) Endoscopic approach to intraventricular cysticercal lesions. Minim Invasive Neurosurg 44(4):194–196. 10.1055/s-2001-19928 Torres-Corzo J, Rodriguez-della Vecchia R, Rangel-Castilla L (2006) Bruns syndrome caused by intraventricular neurocysticercosis treated using flexible endoscopy. J Neurosurg 104(5):746–748. 10.3171/jns.2006.104.5.746 Husain M, Rastogi M, Jha DK, Husain N, Gupta RK (2007) Endoscopic transaqueductal removal of fourth ventricular neurocysticercosis with an angiographic catheter. Neurosurgery 60(4 Suppl 2):249–254. 10.1227/01.NEU.0000255382.72593.81 Husain M, Jha DK, Rastogi M, Husain N, Gupta RK (2007) Neuro-endoscopic management of intraventricular neurocysticercosis (NCC). Acta Neurochir (Wien) 149(4):341–346. 10.1007/s00701-006-1059-z Suri A, Goel RK, Ahmad FU, Vellimana AK, Sharma BS, Mahapatra AK (2008) Endoscopic excision of intraventricular neurocysticercosis in children: a series of six cases and review. Childs Nerv Syst 24(2):281–285. 10.1007/s00381-007-0462-y Goel RK, Ahmad FU, Vellimana AK, Suri A, Chandra PS, Kumar R, Sharma BS, Mahapatra AK (2008) Endoscopic management of intraventricular neurocysticercosis. J Clin Neurosci 15(10):1096–1101. 10.1016/j.jocn.2007.10.004 Jimenez-Vazquez OH, Nagore N (2008) The impact of neuroendoscopy in the emergency setting: a retrospective study of imaging, intraoperative findings, and surgical outcome in 55 patients. Clin Neurol Neurosurg 110(6):539–543. 10.1016/j.clineuro.2008.02.019 Kumar R, Kumar Kalra S, Mahapatra AK (2008) Intraventricular neurocysticercus cyst(s) in Indian children. Pediatr Neurosurg 44(2):118–123. 10.1159/000113113 Rangel-Castilla L, Serpa JA, Gopinath SP, Graviss EA, Diaz-Marchan P, White AC Jr (2009) Contemporary neurosurgical approaches to neurocysticercosis. Am J Trop Med Hyg 80(3):373–378 Torres-Corzo JG, Tapia-Pérez JH, Vecchia RR, Chalita-Williams JC, Sánchez-Aguilar M, Sánchez-Rodríguez JJ (2010) Endoscopic management of hydrocephalus due to neurocysticercosis. Clin Neurol Neurosurg 112(1):11–16. https://doi.org/10.1016/j.clineuro.2009.08.022 Endoscopic intervention for the fourth (2014) ventricular neurocysticercal cyst: what should be the optimum therapeutic approach? Br J Neurosurg 28(5):626–630. 10.3109/02688697.2013.872224 Li Z, Li C, Zhang X, Guan S, Zhang P, Bao J et al (2017) Ventriculoscopic approach for intraventricular neurocysticercosis: a single neurosurgical center’s experience. World Neurosurg 107:853–859. 10.1016/j.wneu.2017.08.059 Nash TE, Ware JM, Mahanty S (2018) Intraventricular neurocysticercosis: experience and long-term outcome from a tertiary referral center in the United States. Am J Trop Med Hyg 98(6):1755–1762. 10.4269/ajtmh.18-0085 Sharma BS, Sawarkar DP, Verma SK (2019) Endoscopic management of fourth ventricle neurocysticercosis: description of a new technique in a case series of five cases and review of the literature. World Neurosurg 122:e647–e654. 10.1016/j.wneu.2018.10.117 Kaif M, Husain M, Ojha BK (2019) Endoscopic management of intraventricular neurocysticercosis. Turk Neurosurg 29(1):59–65. 10.5137/1019-5149.JTN.21389-17.3 Singh S, Marutirao R, Deora H, Das KK, Bhaisora KS, Sardhara J et al (2019) Endoscopic route for excision of intraventricular neurocysticercosis: light at the end of the tunnel. World Neurosurg 125:e74–e81. 10.1016/j.wneu.2018.12.191 Konar S, Kandregula S, Sashidhar A, Prabhuraj AR, Saini J, Shukla D et al (2020) Endoscopic intervention for intraventricular neurocysticercal cyst: challenges and outcome analysis from a single institute experience. Clin Neurol Neurosurg 198:106179. 10.1016/j.clineuro.2020.106179 Aggarwal VK, Krishna G, Singh I (2020) Endoscopic excision of intraventricular neurocysticercosis cyst with an angiocatheter: a retrospective analysis. Asian J Neurosurg 15(3):527–531. 10.4103/ajns.AJNS_112_20 Xu X, Zhang J, Guo Z, Xiong R, Lang S, Gan Z, Chen X (2025) Endoscopic management of intraventricular and subarachnoid neurocysticercosis: technical workflow and clinical outcome. Neurosurg Focus 59(5):E5. 10.3171/2025.8.FOCUS25686 Additional Declarations No competing interests reported. Supplementary Files DraftNCCsupplementarymaterials.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8283848\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Systematic Review\",\"associatedPublications\":[],\"authors\":[{\"id\":593951524,\"identity\":\"f69b0253-03e2-4376-8f6b-887837179ad7\",\"order_by\":0,\"name\":\"Fritz Fidel Váscones-Román\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYBAC9gbGBmS+DRDz4NfCc4CxEVlPGjFaGFCsOUyEFunD7Q9/MByWl28/fOzBhz/nE7eznz3AXFCBRwtfYmODBMNhww1n0tINZ7bdTtzZk5fAPOMMbi32PEC/GDCkMW6Q4DGT5m24nbjhBo8BM28bHltAWhIY0uznzwBq+fPnHFTLPwJaDjDYJDbcAGphYDsA1dKAX8vMBgObZKBf0iR725KNd/bkGByecQyfFvYHH39USNjOB4aYxI8/drLb2c8YPi6owa0FAgzQ2IcJacDUzkyallEwCkbBKBjmAABPS07J3iZdEgAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Universidad Peruana Cayetano Heredia\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Fritz\",\"middleName\":\"Fidel\",\"lastName\":\"Váscones-Román\",\"suffix\":\"\"},{\"id\":593951525,\"identity\":\"ca5ccf6d-8233-4105-9c44-dd320fa2669b\",\"order_by\":1,\"name\":\"Omar Gustavo Perez Nestares\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Universidad Peruana Cayetano Heredia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Omar\",\"middleName\":\"Gustavo Perez\",\"lastName\":\"Nestares\",\"suffix\":\"\"},{\"id\":593951526,\"identity\":\"f820b0f1-78d3-47b8-950e-b70c7a4ff4b9\",\"order_by\":2,\"name\":\"Fernando Canazas-Paredes\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Universidad Peruana Cayetano Heredia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Fernando\",\"middleName\":\"\",\"lastName\":\"Canazas-Paredes\",\"suffix\":\"\"},{\"id\":593951527,\"identity\":\"208fa29d-bd6c-4bc8-be52-966994ca38d1\",\"order_by\":3,\"name\":\"Diana Carolina Salazar Flores\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Universidad Peruana Cayetano Heredia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Diana\",\"middleName\":\"Carolina Salazar\",\"lastName\":\"Flores\",\"suffix\":\"\"},{\"id\":593951528,\"identity\":\"c0581d02-8f3f-4758-b63b-1287fd683324\",\"order_by\":4,\"name\":\"Lynn A. Quintana-García\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Universidad Ricardo Palma\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Lynn\",\"middleName\":\"A.\",\"lastName\":\"Quintana-García\",\"suffix\":\"\"},{\"id\":593951529,\"identity\":\"09b17e69-2ca2-46df-ab89-b9908908be63\",\"order_by\":5,\"name\":\"Wagner Rios-Garcia\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Saint Aloysius Gonzaga National University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Wagner\",\"middleName\":\"\",\"lastName\":\"Rios-Garcia\",\"suffix\":\"\"},{\"id\":593951530,\"identity\":\"d8043f58-9313-4fb2-aa1e-b29e7cd3167f\",\"order_by\":6,\"name\":\"Demy Váscones-Román\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Universidad Andina del Cusco\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Demy\",\"middleName\":\"\",\"lastName\":\"Váscones-Román\",\"suffix\":\"\"},{\"id\":593951531,\"identity\":\"324a4fa2-7b71-47bc-9c86-0c367bcce641\",\"order_by\":7,\"name\":\"Diego Fabrizio Zambrano-Sanchez\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Universidad Peruana Cayetano Heredia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Diego\",\"middleName\":\"Fabrizio\",\"lastName\":\"Zambrano-Sanchez\",\"suffix\":\"\"},{\"id\":593951532,\"identity\":\"0dd56d87-ca36-4fa5-8527-9832012d07ad\",\"order_by\":8,\"name\":\"Karlos Acurio-Ortiz\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Universidad Peruana Cayetano Heredia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Karlos\",\"middleName\":\"\",\"lastName\":\"Acurio-Ortiz\",\"suffix\":\"\"},{\"id\":593951533,\"identity\":\"ef6ce1b6-d36b-4d3a-a97f-912bd66a0815\",\"order_by\":9,\"name\":\"Herbert Saavedra-Pastor\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"National Institute of Neurological Sciences\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Herbert\",\"middleName\":\"\",\"lastName\":\"Saavedra-Pastor\",\"suffix\":\"\"},{\"id\":593951534,\"identity\":\"4e3b7536-a2c2-4d61-a72c-76f348716834\",\"order_by\":10,\"name\":\"William Martinez\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"National Institute of Neurological Sciences\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"William\",\"middleName\":\"\",\"lastName\":\"Martinez\",\"suffix\":\"\"},{\"id\":593951535,\"identity\":\"265007b9-c6a2-4f32-b3e9-10b32a64f3cf\",\"order_by\":11,\"name\":\"Niels Pacheco-Barrios\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Harvard Medical School\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Niels\",\"middleName\":\"\",\"lastName\":\"Pacheco-Barrios\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-12-05 03:38:14\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8283848/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8283848/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":103179468,\"identity\":\"bd886ea5-9a2c-47fc-97d0-d3dba8fc5206\",\"added_by\":\"auto\",\"created_at\":\"2026-02-22 17:12:13\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":93129,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eClinical improvement after endoscopic management of intraventricular neurocysticercosis. \\u003c/strong\\u003e\\u003cem\\u003eForest plot showing the proportion of patients with clinical improvement after endoscopic management of intraventricular neurocysticercosis. Random-effects meta-analysis of 14 studies (214 patients) yielded a pooled proportion of 0.99 (95% CI 0.87–1.00; I² = 0%). Squares represent study-specific estimates (size weighted by inverse variance), and the diamond represents the pooled effect.\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8283848/v1/30f1a935fef770e68186ac40.png\"},{\"id\":103179472,\"identity\":\"ae6bf681-ad15-4e9e-83e8-bdabd1775432\",\"added_by\":\"auto\",\"created_at\":\"2026-02-22 17:12:14\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":72814,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eCure rate after endoscopic management of intraventricular neurocysticercosis. \\u003c/strong\\u003e\\u003cem\\u003eForest plot of cure, defined as absence of cysts on imaging and no symptoms at last follow-up, among patients treated with endoscopic management. Nine studies (152 patients) were included, with a pooled cure proportion of 0.97 (95% CI 0.76–1.00; I² = 0.4%) under a random-effects model. Study-specific proportions are shown as squares with 95% confidence intervals; the diamond indicates the pooled estimate.\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8283848/v1/64879da1ce4e0949f35be179.png\"},{\"id\":103179470,\"identity\":\"f5bab0fa-3735-44e5-bad7-bde2a83a613c\",\"added_by\":\"auto\",\"created_at\":\"2026-02-22 17:12:14\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":114666,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eVentriculoperitoneal shunt requirement following endoscopic management. \\u003c/strong\\u003e\\u003cem\\u003eForest plot of the proportion of patients requiring ventriculoperitoneal shunt (VPS) placement after endoscopic management of intraventricular neurocysticercosis. Nineteen studies (412 patients) contributed data, with a pooled VPS rate of 0.06 (95% CI 0.03–0.14; I² = 15.4%) using a random-effects model. Individual study estimates and 95% confidence intervals are shown, with the pooled effect represented by a diamond.\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8283848/v1/b80bbff0a66aef12baa6c94c.png\"},{\"id\":103505065,\"identity\":\"0bad9622-24a4-49b5-a054-faa7410435a6\",\"added_by\":\"auto\",\"created_at\":\"2026-02-26 13:22:47\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":94075,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003ePerioperative mortality after endoscopic management. \\u003c/strong\\u003e\\u003cem\\u003eForest plot showing perioperative mortality among patients undergoing endoscopic management of intraventricular neurocysticercosis. Sixteen studies (356 patients) were included, with a pooled mortality proportion of 0.01 (95% CI 0.01–0.04; I² = 0%) under a random-effects model. Squares represent study-specific mortality estimates with 95% confidence intervals; the diamond indicates the pooled effect.\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8283848/v1/b941b28e9191e3723b8f8774.png\"},{\"id\":103505675,\"identity\":\"26eb3e46-6a9e-4def-8708-33ad1840ccf8\",\"added_by\":\"auto\",\"created_at\":\"2026-02-26 13:32:34\",\"extension\":\"png\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":113796,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003ePerioperative complications after endoscopic management. \\u003c/strong\\u003e\\u003cem\\u003eForest plot of the proportion of patients experiencing at least one perioperative complication following endoscopic management of intraventricular neurocysticercosis. Nineteen studies (401 patients) were included, yielding a pooled complication rate of 0.10 (95% CI 0.05–0.19; I² = 33.1%) using a random-effects model. Individual study estimates with 95% confidence intervals are displayed as squares and lines, and the diamond represents the pooled estimate.\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image5.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8283848/v1/bc6d832212346d77bea2ef57.png\"},{\"id\":103179465,\"identity\":\"34c51163-ecfb-4d0f-aedd-e76af2547801\",\"added_by\":\"auto\",\"created_at\":\"2026-02-22 17:12:13\",\"extension\":\"png\",\"order_by\":6,\"title\":\"Figure 6\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":60920,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eVentriculoperitoneal shunt requirement: endoscopic management versus conventional surgery. \\u003c/strong\\u003e\\u003cem\\u003eForest plot of odds ratios comparing ventriculoperitoneal shunt (VPS) requirement between endoscopic management and conventional surgical approaches for intraventricular neurocysticercosis. Three comparative studies were included, with a pooled odds ratio of 0.32 (95% CI 0.03–3.59; I² = 0%) under a random-effects model, indicating no statistically significant difference between techniques. Squares represent study-specific odds ratios (size proportional to weight) with 95% confidence intervals; the diamond shows the pooled effect.\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image6.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8283848/v1/6847ef766104acbf9d49abca.png\"},{\"id\":103504796,\"identity\":\"bd03ecc2-74f8-448f-b95c-8a4f5ae6e885\",\"added_by\":\"auto\",\"created_at\":\"2026-02-26 13:21:30\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":2254623,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"DraftNCCsupplementarymaterials.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8283848/v1/097ff4b4db5bb2b4fb9c31be.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Efficacy and safety of endoscopic management in intraventricular neurocysticercosis: a systematic review and meta-analysis\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eNeurocysticercosis (NCC) is a neglected disease with a significant global burden, especially in endemic regions such as Latin America, sub-Saharan Africa, and Southeast Asia [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Intraventricular NCC, a severe subtype, accounts for 7.3% to 61.3% of NCC cases reported in the literature and is often associated with hydrocephalus, cerebrospinal fluid (CSF) obstruction, and increased morbidity and mortality due to its poor response to medical therapy alone [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. These challenges underscore the need for specialized interventions, taking into account parasite location, number, and viability, with various treatment options extending beyond antiparasitic therapy.\\u003c/p\\u003e \\u003cp\\u003eThe advent of neuroendoscopic techniques has expanded treatment possibilities, positioning endoscopic ventriculostomy as a preferred approach in modern practice. In addition to diagnostic benefits from direct visualization, endoscopic management (EM) allows for cyst removal with minimal impact on surrounding brain parenchyma [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. EM has been shown to be effective in reducing the need for ventriculoperitoneal shunting, avoiding complications related to shunt dependence, and managing hydrocephalus through procedures like endoscopic third ventriculostomy (ETV) [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Moreover, EM offers the advantage of preventing ependymitis caused by degenerating cysticerci, which can otherwise lead to CSF obstruction [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eGiven these advantages, endoscopic cyst retrieval has gained traction as a viable alternative to traditional surgery. However, despite its growing use, robust evidence on the long-term efficacy and safety of EM in intraventricular NCC remains limited. Thus, our objective is to systematically assess the efficacy and safety of endoscopic management in intraventricular neurocysticercosis, addressing gaps in current clinical practice and informing future treatment guidelines.\\u003c/p\\u003e \\u003cp\\u003eTo date, only a few systematic reviews have specifically addressed intraventricular NCC, and most have focused either on anatomic subgroups or on technical aspects rather than patient-centred outcomes. Milenković et al. summarized lateral ventricle neurocysticercosis based primarily on case reports and small series, without performing a formal quantitative synthesis of clinical endpoints [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. More recently, Mendieta-Barrera et al. conducted a systematic review and meta-analysis of neuroendoscopic management in IVNCC, emphasizing extent of resection, technical nuances and reintervention rates [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. However, they did not comprehensively pool key clinical outcomes such as overall clinical improvement, cure, shunt dependence and perioperative mortality across all available series, nor did they quantitatively compare endoscopic versus conventional surgery. Building on and extending this work, the present study aims to provide an updated, patient-centred synthesis of endoscopic management for IVNCC, incorporating a larger sample of patients, formal meta-analyses of core clinical outcomes, and exploratory comparisons with conventional surgical approaches.\\u003c/p\\u003e \"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eThis systematic review and meta-analysis was registered in PROSPERO (CRD420251241194) and conducted in accordance with the PRISMA 2020 statement [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. We performed a comprehensive search of PubMed, Embase, Scopus, Web of Science, SciELO and LILACS from inception to November 2025. The search combined keywords and MeSH terms related to \\u0026ldquo;neurocysticercosis\\u0026rdquo;, \\u0026ldquo;intraventricular neurocysticercosis\\u0026rdquo;, \\u0026ldquo;ventricular cysticercosis\\u0026rdquo;, \\u0026ldquo;endoscopic surgery\\u0026rdquo; and \\u0026ldquo;neuroendoscopy\\u0026rdquo;, and was adapted to each database (Supplementary Table \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e). No restrictions were applied on publication date; studies published in English or Spanish and conducted in humans were eligible. Reference lists of relevant articles and reviews were also screened to identify additional studies.\\u003c/p\\u003e \\u003cp\\u003eStudies were included if they (1) involved patients with a diagnosis of intraventricular neurocysticercosis; (2) reported the use of endoscopic management (EM) as part of the treatment (with or without concomitant procedures such as endoscopic third ventriculostomy); and (3) provided data on at least one outcome of interest (clinical improvement, cure, complications, ventriculoperitoneal shunt [VPS] placement or mortality). We excluded case reports, narrative reviews, editorials, conference abstracts, purely parenchymal or subarachnoid forms without intraventricular involvement, and studies focused exclusively on medical therapy without surgical intervention. Only original observational studies (case series or cohort studies) were considered.\\u003c/p\\u003e \\u003cp\\u003eTwo reviewers independently screened titles and abstracts, followed by full-text assessment of potentially eligible articles. Disagreements at any stage were resolved by discussion or, when necessary, consultation with a third reviewer. The study selection process is summarized in a PRISMA flow diagram (Figure \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e). Using a standardized extraction form, two reviewers independently collected data on first author, year of publication, country, study design, sample size, patient demographics, cyst location, endoscopic approach and associated procedures (e.g. EM\\u0026thinsp;+\\u0026thinsp;ETV), use of adjunctive medical therapy when reported, and follow-up duration. For efficacy outcomes, we extracted the number of patients with clinical improvement and those considered cured (no cysts on imaging and no symptoms at last follow-up). For safety outcomes, we recorded the number of patients requiring VPS, experiencing at least one perioperative complication, and dying in the perioperative period. When necessary, authors\\u0026rsquo; definitions of outcomes were harmonised to fit these categories, and discrepancies in extracted data were resolved by consensus.\\u003c/p\\u003e \\u003cp\\u003eBecause all included studies were observational, risk of bias was evaluated at the study level using domains adapted from ROBINS-I for non-randomised studies [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. We assessed selection of participants, deviations from intended interventions, completeness of outcome data, outcome measurement and selective reporting, and classified each study as having low, moderate or serious risk of bias; disagreements were resolved by discussion.\\u003c/p\\u003e \\u003cp\\u003eWe performed meta-analyses of proportions for clinical improvement, cure, VPS placement, perioperative complications and perioperative mortality among patients treated with EM. For comparative studies, we pooled odds ratios (ORs) for VPS requirement in EM versus conventional surgery. Random-effects models were used throughout to account for between-study heterogeneity. Proportions were analysed using logit transformation to stabilise variances; for ORs, standard random-effects models were applied. Statistical heterogeneity was quantified using the I\\u0026sup2; statistic and τ\\u0026sup2;, considering I\\u0026sup2; values of 25%, 50% and 75% as low, moderate and high heterogeneity, respectively. Where appropriate, 95% prediction intervals were calculated to estimate the expected range of effects in future settings. All analyses were conducted using R (R Foundation for Statistical Computing, Vienna, Austria) with the meta and metafor packages.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eStudy selection and characteristics\\u003c/p\\u003e \\u003cp\\u003eFrom 1447 records identified through the database search, 21 studies met the inclusion criteria, contributing a total of 439 patients with intraventricular NCC (Figure \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e). All studies were observational (case series or retrospective cohorts); several included a comparative group treated with conventional surgery or medical therapy.\\u003c/p\\u003e \\u003cp\\u003eOverall, 384 patients underwent endoscopic management (EM), with or without concomitant steroid therapy. Endoscopic approaches included transcortical, transforaminal, transaqueductal, transventricular and transcallosal routes. Cysts were located in the lateral ventricles in 79 patients, the third ventricle in 63, the fourth ventricle in 180 and other sites (such as the aqueduct of Sylvius or basal cisterns) in 6 patients; several patients harboured cysts in more than one ventricle. Among those treated endoscopically, 163 underwent endoscopic cyst removal only, while others had endoscopic third ventriculostomy or combined procedures.\\u003c/p\\u003e \\u003cp\\u003eNot all studies reported the same outcomes. Across studies that provided data, 214 patients had information on clinical improvement, 152 on cure, 412 on VPS placement, 356 on perioperative mortality and 401 on perioperative complications. The main characteristics of the included studies are summarized in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eIncluded studies with extracted variables.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"12\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAuthor, year\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCountry\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eStudy design\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eIVNCC patients, n\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eEndoscopic management, n\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eEndoscopic cyst removal only, n\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eEndoscopic approach*\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eCyst location\\u0026dagger;\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eClinical improvement, n/N\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eCure, n/N\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003eComplications, n/N\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eMortality, n/N\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eApuzzo M, 1984 [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscallosal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 5\\u003c/p\\u003e \\u003cp\\u003eIII: 12\\u003c/p\\u003e \\u003cp\\u003eIV: 24 Aqueduct of Sylvius: 4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBergsneider M, 1999\\u003c/p\\u003e \\u003cp\\u003e[20]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTransforaminal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eIV: 5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBergsneider M, 2000\\u003c/p\\u003e \\u003cp\\u003e[\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscortical (precoronal frontal)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 6 III: 4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnandh B, 2001\\u003c/p\\u003e \\u003cp\\u003e[22]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscortical, transaqueductal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 4\\u003c/p\\u003e \\u003cp\\u003eIII: 1\\u003c/p\\u003e \\u003cp\\u003eIV: 3 Lateral\\u0026thinsp;+\\u0026thinsp;III: 1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTorres-Corzo J, 2006\\u003c/p\\u003e \\u003cp\\u003e[23]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMexico\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTransforaminal, transaqueductal, frontal precoronal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eIII: 7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHusain M 2007, \\u003c/p\\u003e \\u003cp\\u003e[24]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscortical (precoronal frontal)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eIV: 10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHusain M, 2007\\u003c/p\\u003e \\u003cp\\u003e[25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscortical, transaqueductal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 6 III: 6 IV: 10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSuri A, 2008\\u003c/p\\u003e \\u003cp\\u003e[26]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscortical, transforaminal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 1\\u003c/p\\u003e \\u003cp\\u003eIV: 5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGoel A, 2008\\u003c/p\\u003e \\u003cp\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscortical, transaqueductal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 4 III: 3 IV: 14 Lateral\\u0026thinsp;+\\u0026thinsp;III: 1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eJimenez-Vazquez O, 2008\\u003c/p\\u003e \\u003cp\\u003e[28]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMexico\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKumar A, 2008\\u003c/p\\u003e \\u003cp\\u003e[29]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscallosal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 4\\u003c/p\\u003e \\u003cp\\u003eIV: 4\\u003c/p\\u003e \\u003cp\\u003eForamen of monro: 2\\u003c/p\\u003e \\u003cp\\u003eAqueduct: 1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRangel-Castilla L, 2009\\u003c/p\\u003e \\u003cp\\u003e[30]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eRetrospective observational study\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTorres-Corzo J, 2010\\u003c/p\\u003e \\u003cp\\u003e[31]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMexico\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCohort\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscortical\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 6 III: 6 IV: 20 Subarachnoid space:24 Cerebral aqueduct: 1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRanjan S, 2014\\u003c/p\\u003e \\u003cp\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eRetrospective observational study\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTransventricular, transforaminal, transaqueductal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eIV: 21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eZhenye L, 2017\\u003c/p\\u003e \\u003cp\\u003e[33]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eChina\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eRetrospective observational study\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscortical\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eSolitary NCC: 4 2 or more NCC: 17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e18\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNash TE, 2018\\u003c/p\\u003e \\u003cp\\u003e[34]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eRetrospective review\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral 11 III: 2 IV: 16 Aqueduct 1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSharma BS,2019\\u003c/p\\u003e \\u003cp\\u003e[35]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscortical, transforaminal, transaqueductal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eIV: 4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKaif M, 2018\\u003c/p\\u003e \\u003cp\\u003e[36]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscortical, Transaqueductal, Transforaminal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 1 III: 16\\u003c/p\\u003e \\u003cp\\u003eIV: 12\\u003c/p\\u003e \\u003cp\\u003eSeptum Cavum: 1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSingh G, 2019\\u003c/p\\u003e \\u003cp\\u003e[37]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTransforaminal, transaqueductal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 3 III: 1\\u003c/p\\u003e \\u003cp\\u003eIV: 7\\u003c/p\\u003e \\u003cp\\u003eLateral\\u0026thinsp;+\\u0026thinsp;III: 1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKonar S, 2020\\u003c/p\\u003e \\u003cp\\u003e[38]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCase Series\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTransventricular, trans foraminal, trans aqueductal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 18\\u003c/p\\u003e \\u003cp\\u003eIII: 9\\u003c/p\\u003e \\u003cp\\u003eIV: 34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eNR\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAggarwal VK, 2020\\u003c/p\\u003e \\u003cp\\u003e[39]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eRetrospective observational study\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTranscortical, transqueductal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 4 III: 14\\u003c/p\\u003e \\u003cp\\u003eIV: 8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eXu et al., 2025\\u003c/p\\u003e \\u003cp\\u003e[40]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eChina\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eRetrospective observational study\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eTransventricular, transforaminal, tranaqueductal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eLateral: 8\\u003c/p\\u003e \\u003cp\\u003eIII:2\\u003c/p\\u003e \\u003cp\\u003eIV:2\\u003c/p\\u003e \\u003cp\\u003eBasal subaracnoideo cistern: 1\\u003c/p\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;2 locations: 38\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e51\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"12\\\"\\u003e\\u003cem\\u003e*Endoscopic approach as reported by the authors (e.g. transcortical, transforaminal, transaqueductal, transventricular, transcallosal).\\u003c/em\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"12\\\"\\u003e\\u003cem\\u003e\\u0026dagger;Number of patients with cysts in each ventricular compartment: LV, lateral ventricle; III, third ventricle; IV, fourth ventricle; Aq, aqueduct of Sylvius; \\u0026ldquo;\\u0026ge;2 ventricles\\u0026rdquo; indicates patients with cysts in more than one ventricular location.\\u003c/em\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"12\\\"\\u003e\\u003cem\\u003eAbbreviations: IVNCC, intraventricular neurocysticercosis; EM, endoscopic management; LV, lateral ventricle; VPS, ventriculoperitoneal shunt; NR, not reported.\\u003c/em\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eEfficacy outcomes\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eClinical improvement\\u003c/h2\\u003e \\u003cp\\u003eFourteen studies reported clinical improvement after EM, encompassing 214 patients, of whom 210 improved clinically. The pooled proportion of patients with clinical improvement was 0.99 (95% CI 0.87\\u0026ndash;1.00) under a random-effects model, corresponding to an estimated 99% improvement rate (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Statistical heterogeneity was negligible (I\\u0026sup2; = 0%), indicating consistent results across studies.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eCure\\u003c/h3\\u003e\\n\\u003cp\\u003eNine studies (152 patients) reported cure, defined as absence of cysts on imaging and no symptoms at last follow-up; 143 patients met this criterion. The pooled cure proportion was 0.97 (95% CI 0.76\\u0026ndash;1.00) with a random-effects model, i.e. an estimated 97% cure rate (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). Heterogeneity was very low (I\\u0026sup2; = 0.4%), suggesting that cure rates were highly consistent among studies.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eSafety outcomes\\u003c/p\\u003e\\n\\u003ch3\\u003eVentriculoperitoneal shunt (VPS) requirement\\u003c/h3\\u003e\\n\\u003cp\\u003eNineteen studies reported VPS placement in 412 patients treated endoscopically; 35 required a VPS during follow-up. The pooled proportion of patients needing a VPS after EM was 0.06 (95% CI 0.03\\u0026ndash;0.14) using a random-effects model, corresponding to an estimated 6% VPS rate (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). Heterogeneity was low (I\\u0026sup2; = 15.4%), indicating relatively modest variability in shunt requirement among studies.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003ePerioperative mortality\\u003c/h3\\u003e\\n\\u003cp\\u003eSixteen studies (356 patients) reported perioperative mortality, with 5 deaths observed. The pooled mortality proportion was 0.01 (95% CI 0.01\\u0026ndash;0.04) under a random-effects model, i.e. an estimated 1% perioperative mortality rate (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e). There was no statistical heterogeneity (I\\u0026sup2; = 0%), reflecting highly consistent mortality estimates.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003ePerioperative complications\\u003c/h3\\u003e\\n\\u003cp\\u003eNineteen studies with 401 patients provided data on perioperative complications; 44 patients experienced at least one complication. The pooled complication proportion was 0.10 (95% CI 0.05\\u0026ndash;0.19), corresponding to an estimated 10% complication rate after EM (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e). Heterogeneity was moderate (I\\u0026sup2; = 33.1%), suggesting some variability in reported complication rates, likely due to differences in surgical technique, complication definitions and reporting across studies.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eComparison between endoscopic management and conventional surgery\\u003c/p\\u003e \\u003cp\\u003eThree studies directly compared EM with conventional surgical approaches for intraventricular NCC in terms of VPS requirement. The random-effects meta-analysis showed no statistically significant difference between EM and conventional surgery (odds ratio 0.32, 95% CI 0.03\\u0026ndash;3.59, I\\u0026sup2; = 0%; Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig6\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e). Although the point estimate favoured EM (lower odds of VPS), the wide confidence interval reflects the small number of comparative studies and limited statistical power.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eRisk of bias\\u003c/p\\u003e \\u003cp\\u003eAll included studies were observational and generally judged at moderate to serious risk of bias, mainly due to non-consecutive patient inclusion, lack of control groups, heterogeneous and sometimes poorly defined outcome measures, and incomplete reporting of follow-up. These limitations reduce the overall certainty of the evidence and should be considered when interpreting the pooled estimates (Figure S2).\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this systematic review and meta-analysis of 21 observational studies including 439 patients with intraventricular neurocysticercosis (IVNCC), we found that neuroendoscopic management is associated with excellent clinical outcomes and an acceptable safety profile. Pooled proportions showed that 99% of patients improved clinically and 97% achieved cure at last follow-up, while only 6% required a ventriculoperitoneal shunt (VPS), 10% experienced perioperative complications and 1% died. These findings support endoscopic management (EM) as a first-line strategy for appropriately selected patients with IVNCC, particularly those with obstructive hydrocephalus and cysts in surgically accessible ventricular locations, in line with contemporary guidelines that advocate surgical removal of ventricular cysts whenever feasible [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eOur findings also add important incremental value to the existing body of literature on IVNCC. Milenković et al. provided a comprehensive qualitative synthesis of lateral ventricle neurocysticercosis but did not perform a quantitative meta-analysis of outcomes and largely restricted their scope to a single ventricular compartment [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Mendieta-Barrera et al. subsequently reported a systematic review and meta-analysis of neuroendoscopic management in IVNCC, focusing on complete cyst resection rates, reintervention and selected complications in 314 patients [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. In contrast, our work pools data from 439 patients across all ventricular locations and centres its analyses on clinically meaningful endpoints\\u0026mdash;global clinical improvement, cure, shunt dependence, perioperative complications and mortality\\u0026mdash;thereby offering a more direct estimate of the real-world benefit\\u0026ndash;risk profile of endoscopic management. Moreover, by incorporating the limited comparative data available, we provide the first quantitative synthesis of ventriculoperitoneal shunt requirement in endoscopic versus conventional surgical approaches, while explicitly framing our conclusions within a health-systems and global neurosurgery perspective. Taken together, these features position our study as a complementary and patient-focused update to prior technical and anatomically oriented reviews [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eComparison with previous literature\\u003c/p\\u003e \\u003cp\\u003eOur results are consistent with and extend the findings of prior single-centre series that established neuroendoscopy as an effective option for IVNCC. Bergsneider et al. reported high rates of symptom resolution and cyst removal using endoscopic approaches to the lateral and third ventricles, with most patients avoiding permanent shunting [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Husain et al. similarly demonstrated restoration of CSF flow and excellent functional outcomes following neuroendoscopic surgery, even when cysts could only be partially removed [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Subsequent series from Mexico and India, among others, confirmed that endoscopic cystectomy combined with endoscopic third ventriculostomy (ETV) could effectively treat hydrocephalus while minimizing brain manipulation and postoperative morbidity [\\u003cspan additionalcitationids=\\\"CR5\\\" citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. Our pooled cure rate of 97%, derived from a larger and more diverse sample, quantitatively reinforces these observations and suggests that durable cyst eradication is achievable in the vast majority of endoscopically treated patients.\\u003c/p\\u003e \\u003cp\\u003eA recent systematic review and meta-analysis by Mendieta-Barrera et al. focused specifically on neuroendoscopic management of IVNCC and reported complete cyst resection in 90% of 314 patients, with reintervention in only 3% and very low rates of serious complications [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. That study primarily emphasized technical aspects\\u0026mdash;such as the superiority of flexible over rigid endoscopes for fourth-ventricle cysts and the potential benefits of postoperative anthelmintic therapy\\u0026mdash;rather than systematically quantifying patient-centred outcomes. Our work complements and expands this evidence by pooling clinically meaningful endpoints (cure, overall clinical improvement, VPS dependence and mortality) across 439 patients, including additional recent series. Together, both meta-analyses converge on the message that neuroendoscopic surgery is highly effective and safe for IVNCC when performed in experienced centres, while our study further clarifies its clinical impact at the patient and health-system levels [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eReduction in shunt dependence\\u003c/p\\u003e \\u003cp\\u003eOne of the most clinically relevant findings of our study is the low pooled VPS requirement of 6% after EM. Historically, many patients with IVNCC were treated primarily with CSF shunting, often without cyst removal, particularly where microsurgical or endoscopic expertise was limited [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. However, VPS is associated with substantial long-term failure rates: in pediatric and young adult hydrocephalus cohorts, 30\\u0026ndash;40% of shunts malfunction within the first year and approximately 50% by two years, with many patients requiring multiple revisions over their lifetime [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. Shunt infection alone has been reported in 5\\u0026ndash;12% of cases and markedly increases morbidity and mortality [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eAgainst this background, the ability of EM to relieve obstruction and control hydrocephalus while avoiding permanent shunt placement in ~\\u0026thinsp;94% of patients is notable. Even in those who eventually required a VPS, endoscopic debulking and ETV may still reduce shunt dependency and simplify subsequent management [\\u003cspan additionalcitationids=\\\"CR4 CR5\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR13\\\" citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. These findings support current international guidelines, which recommend endoscopic removal of ventricular cysts, with or without ETV, as the preferred strategy and discourage shunt-only approaches whenever technically feasible [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eSafety profile of neuroendoscopic surgery\\u003c/p\\u003e \\u003cp\\u003eWe observed a pooled perioperative complication rate of 10% and a mortality rate of 1%, with no between-study heterogeneity for mortality. Reported complications included transient neurological deficits, intraoperative bleeding, cyst rupture, CSF leak and infection; most were self-limited or manageable with standard neurosurgical care. These rates compare favourably with those reported for open microsurgical approaches to IVNCC and for VPS surgery in general hydrocephalus populations, where overall complication and failure rates often exceed 20\\u0026ndash;30% [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eOur results also align with Mendieta-Barrera et al., who found low rates of intraoperative bleeding (0.8%), cyst rupture (0.5%) and infection-related mortality (0.9%) after neuroendoscopic procedures [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. The slightly higher overall complication rate in our pooled analysis likely reflects broader definitions of complications and inclusion of heterogeneous observational series with variable reporting quality. Nonetheless, the combination of very high cure and improvement rates with low mortality suggests that, in experienced hands, the benefit\\u0026ndash;risk profile of EM for IVNCC is favourable.\\u003c/p\\u003e \\u003cp\\u003eEndoscopy versus conventional surgery\\u003c/p\\u003e \\u003cp\\u003eIn the three comparative studies included, EM did not show a statistically significant advantage over conventional microsurgical approaches regarding VPS requirement (OR 0.32, 95% CI 0.03\\u0026ndash;3.59). This lack of statistical significance should be interpreted cautiously. First, the small number of comparative studies and patients yields wide confidence intervals and limited power to detect differences. Second, selection bias is likely: endoscopy may have been preferentially offered to cases with more favourable anatomy (e.g. single cysts in accessible locations), whereas more complex lesions or those with dense adhesions were directed to open surgery [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. Third, outcomes such as length of stay, recovery time, quality of life and cost\\u0026mdash;which may favour minimally invasive approaches\\u0026mdash;were rarely reported.\\u003c/p\\u003e \\u003cp\\u003eDespite these limitations, the available evidence suggests that EM achieves at least comparable, and possibly superior, outcomes to conventional craniotomy for many patients with IVNCC, while offering theoretical advantages in terms of reduced tissue trauma, better visualization of ventricular anatomy and the possibility of combined ETV [\\u003cspan additionalcitationids=\\\"CR4 CR5\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR12 CR13 CR14\\\" citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. Future prospective comparative studies should stratify patients by ventricular location, cyst burden, and presence of basal subarachnoid disease, and should incorporate patient-centred outcomes such as quality of life, time to functional recovery and health-care costs, to more precisely define which subgroups derive the greatest benefit from an endoscopic versus open approach.\\u003c/p\\u003e \\u003cp\\u003eRole of adjunctive medical therapy and technical considerations\\u003c/p\\u003e \\u003cp\\u003eThe optimal integration of antiparasitic drugs and corticosteroids with EM remains uncertain. The 2017 IDSA/ASTMH guidelines recommend surgical removal of ventricular cysts as first-line therapy, with cautious use of perioperative corticosteroids to limit inflammatory responses and selective use of albendazole or praziquantel depending on the presence of parenchymal or subarachnoid disease [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Mendieta-Barrera et al. reported that postoperative anthelmintic therapy significantly improved outcomes, from 69% to 96%, in patients undergoing neuroendoscopic cyst removal [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. However, few of the primary studies in our meta-analysis provided sufficient detail to evaluate the independent contribution of antiparasitic therapy to long-term outcomes.\\u003c/p\\u003e \\u003cp\\u003eSimilarly, technical variables such as the use of flexible versus rigid endoscopes, the performance of concurrent ETV, and strategies to manage adherent or multiple cysts could not be systematically analysed. Existing series suggest that flexible endoscopes improve access to fourth-ventricle cysts and may increase complete resection rates [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e], whereas ETV may reduce subsequent shunt dependence, particularly in patients with aqueductal obstruction or fourth-ventricle outlet obstruction [\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Prospective registries that systematically capture these technical details, as well as standardized outcome measures, are needed to refine surgical decision-making [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eClinical and global health implications\\u003c/p\\u003e \\u003cp\\u003eIVNCC occurs predominantly in low- and middle-income countries where Taenia solium is endemic and access to advanced neurosurgical care is limited [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. The high cure and low shunt-dependence rates associated with EM have important implications for health systems with constrained resources. Shunt complications and repeated revisions are costly, require specialized care and may be catastrophic for patients living far from neurosurgical centres [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. Investment in basic neuroendoscopic infrastructure and training in endemic regions could therefore yield disproportionate benefits by reducing long-term morbidity and healthcare utilization. At the same time, implementation must be accompanied by robust perioperative protocols and follow-up systems to ensure patient safety and maintain surgical quality [\\u003cspan additionalcitationids=\\\"CR4 CR5\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eLimitations\\u003c/p\\u003e \\u003cp\\u003eThis review has several limitations. First, all included studies were observational case series or retrospective cohorts, often with small sample sizes, incomplete follow-up and heterogeneous reporting; as a result, the overall certainty of evidence is low. Second, there was variability in the definitions of \\u0026ldquo;cure\\u0026rdquo;, \\u0026ldquo;clinical improvement\\u0026rdquo; and \\u0026ldquo;complication\\u0026rdquo;, as well as in the timing of outcome assessment, which may have introduced misclassification and contributed to residual heterogeneity. Third, most series originated from high-volume referral centres in a limited number of countries, potentially limiting generalizability to lower-volume or resource-constrained settings. Fourth, publication bias is possible, as unsuccessful or highly complicated cases are less likely to be reported. Finally, our ability to perform meaningful subgroup analyses (e.g. by ventricular location, extent of cyst burden, type of endoscope, use of ETV or adjuvant therapy) was limited by incomplete data.\\u003c/p\\u003e \\u003cp\\u003eFuture directions\\u003c/p\\u003e \\u003cp\\u003eFuture research should prioritize prospective, multicentre registries of IVNCC that use standardized diagnostic criteria,[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e] uniform definitions of outcomes and complications, and long-term follow-up to capture recurrence, shunt failure and quality of life. Pragmatic comparative studies or carefully designed observational cohorts with robust adjustment for confounders are needed to clarify the relative benefits of EM versus microsurgical resection and to define indications for each technique.[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e] In parallel, studies evaluating the incremental value of flexible endoscopes, intraoperative neuronavigation, and postoperative antiparasitic therapy could further optimize treatment algorithms.[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e] Given the concentration of IVNCC in low-resource settings, partnerships between endemic-country centres and high-income institutions will be essential to build capacity, generate high-quality data and ensure that advances in endoscopic technology translate into real-world improvements in patient outcomes.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eIntraventricular neurocysticercosis is a severe form of NCC that is frequently complicated by obstructive hydrocephalus and historically managed with CSF shunting alone. In this systematic review and meta-analysis of 21 observational studies, endoscopic management was associated with very high rates of clinical improvement and cure, a low need for ventriculoperitoneal shunting and low perioperative mortality, supporting its role as a first-line therapeutic option for appropriately selected patients with IVNCC. These findings are consistent across centres and align with current guideline recommendations favouring surgical removal of ventricular cysts whenever feasible.\\u003c/p\\u003e \\u003cp\\u003eNevertheless, the available evidence is limited by the observational nature of the included studies, heterogeneous reporting and potential selection bias, resulting in low overall certainty of evidence. Prospective, multicentre cohorts and comparative studies that incorporate standardized outcome definitions, longer-term follow-up and patient-centred endpoints are needed to better define the relative benefits of endoscopic versus open approaches, the role of adjunctive medical therapy and the optimal management of complex or recurrent disease. Expanding access to safe neuroendoscopic surgery in endemic, resource-limited settings should be a parallel priority, given the potential of this strategy to reduce shunt dependence, long-term morbidity and health-care burden in this vulnerable patient population.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eDisclosures:\\u003c/strong\\u003e The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical trial number:\\u0026nbsp;\\u003c/strong\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate declarations:\\u0026nbsp;\\u003c/strong\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical trial registration:\\u0026nbsp;\\u003c/strong\\u003eClinical trial number: Not applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests:\\u0026nbsp;\\u003c/strong\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u0026nbsp;\\u003c/strong\\u003eNo external funding was received for this study.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eFFVR, KAO and NPB conceived and designed the study. FFVR, OGPN, FCP, DCSF, LAQG, WRG, DVR, DFZS and KAO performed the literature search, study selection and data extraction. FFVR, OGPN, FCP and NPB conducted the statistical analyses and prepared the figures and tables. HSP, WM and NPB provided clinical and methodological oversight and contributed to the interpretation of the results. FFVR drafted the first version of the manuscript. All authors critically revised the manuscript for important intellectual content, approved the final version of the article, and agree to be accountable for all aspects of the work.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eBouteille B (2014) \\u0026Eacute;pid\\u0026eacute;miologie de la cysticercose et de la neurocysticercose [Epidemiology of cysticercosis and neurocysticercosis]. Med et sante tropicales 24(4):367\\u0026ndash;374\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGarcia HH, Nash TE, Del Brutto OH (2014) Clinical symptoms, diagnosis, and treatment of neurocysticercosis. Lancet Neurol 13(12):1202\\u0026ndash;1215\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSacko O, Boetto S, Lauwers-Cances V, Dupuy M, Roux F (2010) Endoscopic third ventriculostomy: outcome analysis in 368 procedures: Clinical article. J Neurosurgery: Pediatr PED 5(1):68\\u0026ndash;74\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDe Marco R, Lacatena F, Cofano F, Garbossa D, Fiumefreddo A (2024) A case-based review on the neuroendoscopic management of intraventricular and subarachnoid basal neurocysticercosis. Clin Neurol Neurosurg 240:108268\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKonar S, Kandregula S, Sashidhar A et al Endoscopic intervention for intraventricular neurocysticercal cyst: Challenges and outcome analysis from a single institute experience. Clin Neurol Neurosurg\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eZhenye L, Chuzhong L, Xuyi Z et al (2017) Ventriculoscopic Approach for Intraventricular Neurocysticercosis: A Single Neurosurgical Center's Experience. World Neurosurg 107:853\\u0026ndash;859\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ [Internet]. ; n71. 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BMJ 355:i4919. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1136/bmj.i4919\\u003c/span\\u003e\\u003cspan address=\\\"10.1136/bmj.i4919\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDe Marco R, Lacatena F, Cofano F, Garbossa D, Fiumefreddo A (2024) A case-based review on the neuroendoscopic management of intraventricular and subarachnoid basal neurocysticercosis. 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Asian J Neurosurg 15(3):527\\u0026ndash;531. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.4103/ajns.AJNS_112_20\\u003c/span\\u003e\\u003cspan address=\\\"10.4103/ajns.AJNS_112_20\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eXu X, Zhang J, Guo Z, Xiong R, Lang S, Gan Z, Chen X (2025) Endoscopic management of intraventricular and subarachnoid neurocysticercosis: technical workflow and clinical outcome. Neurosurg Focus 59(5):E5. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3171/2025.8.FOCUS25686\\u003c/span\\u003e\\u003cspan address=\\\"10.3171/2025.8.FOCUS25686\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Neurocysticercosis, Endoscopic management, Efficacy, Safety\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8283848/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8283848/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eIntraventricular neurocysticercosis (IVNCC) is a severe form of neurocysticercosis frequently associated with obstructive hydrocephalus and poor response to medical therapy alone. Neuroendoscopic procedures have been increasingly used to remove cysts and treat hydrocephalus, but their efficacy and safety have not been systematically quantified.\\u003c/p\\u003e\\u003ch2\\u003eObjective\\u003c/h2\\u003e \\u003cp\\u003eTo assess the efficacy and safety of endoscopic management (EM) in patients with IVNCC.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eWe systematically searched PubMed, Embase, Scopus, Web of Science, SciELO and LILACS from inception to November 2025 for observational studies reporting outcomes of EM in IVNCC. Primary efficacy outcomes were clinical improvement and cure (no cysts on imaging and no symptoms) at last follow-up. Safety outcomes included perioperative complications, ventriculoperitoneal shunt (VPS) placement and mortality. Random-effects meta-analyses of proportions and odds ratios were performed.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eWe included 21 studies comprising 439 patients with IVNCC, of whom 384 underwent EM. The pooled proportion of patients with clinical improvement was 0.99 (95% CI 0.87\\u0026ndash;1.00), and the pooled cure rate was 0.97 (95% CI 0.76\\u0026ndash;1.00). The pooled proportions were 0.06 (95% CI 0.03\\u0026ndash;0.14) for VPS placement, 0.10 (95% CI 0.05\\u0026ndash;0.19) for perioperative complications and 0.01 (95% CI 0.01\\u0026ndash;0.04) for perioperative mortality. In three comparative studies, there was no statistically significant difference between EM and conventional surgical approaches in terms of VPS requirement (odds ratio 0.32, 95% CI 0.03\\u0026ndash;3.59). Overall, the certainty of evidence was low due to the observational design and risk of bias.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eEndoscopic management for IVNCC is associated with very high rates of clinical improvement and cure, a low need for VPS and low perioperative mortality, supporting its use as a first-line option in appropriately selected patients. However, the current evidence is based on observational studies with important limitations; prospective comparative studies are needed to better define the role of EM versus conventional surgery.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Efficacy and safety of endoscopic management in intraventricular neurocysticercosis: a systematic review and meta-analysis\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-02-22 17:12:09\",\"doi\":\"10.21203/rs.3.rs-8283848/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"8f583b9e-9da4-431b-9c98-61e6d2eea802\",\"owner\":[],\"postedDate\":\"February 22nd, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-02-22T17:12:09+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-02-22 17:12:09\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8283848\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8283848\",\"identity\":\"rs-8283848\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}