Fourth ventricle neurocysticercosis with hydrocephalus: A case report and literature review

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BACKGROUND Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and remains an important cause of neurological morbidity worldwide. Intraventricular NCC may lead to obstructive hydrocephalus and often requires surgical management. The fourth ventricle is the most frequently involved intraventricular location but poses specific diagnostic and therapeutic challenges. CASE SUMMARY A 60-year-old woman presented with persistent headache, dizziness, and recent onset nausea and vomiting. Brain magnetic resonance imaging revealed obstructive hydrocephalus caused by a cystic lesion in the fourth ventricle with an eccentrically located scolex suggestive of NCC. Serological testing confirmed the diagnosis. An endoscopic third ventriculostomy was initially performed to treat hydrocephalus and avoid shunt placement. Although the patient initially improved, she returned 5 weeks later with recurrent symptoms, and imaging revealed cyst enlargement. Therefore, a suboccipital craniotomy with a telovelar approach was performed, allowing complete en bloc removal of the lesion. Histopathology confirmed Taenia solium cysticercosis. The postoperative course was uneventful and antiparasitic therapy was not administered. At the 1-year follow-up, the patient remained asymptomatic with no radiological recurrence. CONCLUSION Fourth ventricle NCC may require direct surgical removal when cerebrospinal fluid diversion alone is insufficient. Microsurgical excision remains an effective treatment option.

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