Efficacy and safety of endoscopic management in intraventricular neurocysticercosis: a systematic review and meta-analysis

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.