Cysticercosis is the most frequent parasitosis of the central nervous system. Often medical treatment does not influence on ventricular or cisternal cysts or doesn't prevent the occurence of complications, such as hydrocephalus. So a considerable group of patients require surgical procedures, especially in cases of neural compression or intracranial hypertension or epilepsy. Recently stereotactic endoscopic removal of intraaxial small lesions using a stereotactic guiding tube and a fine endoscope was reported. We tried to control the symptomatic neurocy-sticercosis using the stereotatic endoscopic system.

We operated 4 cases of neurocysticercosis. Cerebrospinal fluid(CSF)analysis, enhanced com-puterized tomogram(CT) and magnetic resonance image(MRI) scan were performed. There were no specific findings in CSF analysis. CT and MRI scan showed single intraparenchymal lesion in 2 cases, one was cystic and the other was solid, multiple intraventricular cysts with obstructive hydrocephalus in 1 case and mixed type in 1 case. Seizures occured in all patients, partial sensory type in 3 cases who had reciprocal intraparenchymal lesion, generalized type in 1 case who had obstructive hydrocephalus by multple ventricular cysts.

For parenchymal lesions, we planned stereotactic open system endoscopic surgery with variable forceps, laser and suction. Cystic forms were removed successfully but in solid form additional transgyral microscopic removal was needed. In intraventricular lesions, we first placed stereotactic guiding tube via frontal burr hole, then replaced this to 14 Fr peelaway patheter. Through the peelaway catheter we inserted closed system endoscopy and removed the cysts with variable forceps and suctions. All intraparenchymal and intraventricular lesions were removed without specific complications except transient chemical meningitis in one case.

Stereotactic endoscopic surgery make it possible to operate cystic lesions without dege-neration(vesicular stage)wherever they locate.

The neuroendoscopic third ventriculostomy is becoming the standard treatment for aquired aqueduct stenosis because of its exellent results and very low morbidity. Usually the floor of third ventricle is perforated by closed forcep. Fogarty catheter, laser, saline torch, monopolar coagulator and endoscope itself. Whatever the method of ventriculostomy, the obstruction may occur. Recently the author experienced a case of obstruction at the previous site of third ventriculostomy. A 54 yr old man who had long standing ataxia developed headache, vomiting and urinary incontinence suddenly. It was revealed that he had cerebellar tumor, which had compressed the aqueduct of Sylvius anteriorly. I performed the endoscopic third ventriculostomy by monopolar coagulator and Fogarty ballon catheter. During this procedure, there was some bleeding from opening margin but all these bleedings were stopped by rinsing and electric coagulation. He was improved immediately in the postoperative period. 1 month later, the reattack of hydrocephalus developed and it was operated. On intraoperative view, the newly grown gliotic plug originated from the right mammillary body. On 5th day after reoperation., the patency of the artficial aqueduct was confirmed by 2-D cine PC MR CSF(2 dimensional cine phase contrast magnetic resonance cerebrospinal fluid) flow study.

I may suggest that in order to minimize the occlusion the opening should be made at the center of midline, thinnest area in front of both mammillary bodies, with less bleeding and without electric coagulation.

The concepts of hydrocephalus can be applied at all conditions in which the intracranial volume of the cerebrospinal fluid is abnormally largd in relation to the volume of the brain. Most patients suffering from hydrocephalus has increased significantly with the advent of more sophisticated diagmostic tools sucy as CT, MRI and with rapid technical advances in shunt equipment. Since intracranial pressure is variable parameter depending on the factors as that some shunt complication are related to too much or to little cerebrospinal fluid drainage. In this report, the author analyzes post shunt complications of 46 patients from Jan, 1990 to Dec, 1994.

The rate of post shunt complications was 30% and the most common things were underdrtainage(16%), infction(10%), and shunt malfunction(6%).