Creatura D, El Choueiri J, Anselmi L, Di Cosmo L, Bono BC, Rampini AD, Lanterna LAA. Fourth ventricle neurocysticercosis with hydrocephalus: A case report and literature review. World J Clin Cases 2026; 14(13): 117403 [DOI: 10.12998/wjcc.v14.i13.117403]
Corresponding Author of This Article
Jad El Choueiri, School of Medicine, Humanitas University, Via Rita Levi Montalcini 4, Milan 20072, Lombardy, Italy. jad.elchoueiri@st.hunimed.eu
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Surgery
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Case Report
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May 6, 2026 (publication date) through Apr 23, 2026
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World Journal of Clinical Cases
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2307-8960
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Creatura D, El Choueiri J, Anselmi L, Di Cosmo L, Bono BC, Rampini AD, Lanterna LAA. Fourth ventricle neurocysticercosis with hydrocephalus: A case report and literature review. World J Clin Cases 2026; 14(13): 117403 [DOI: 10.12998/wjcc.v14.i13.117403]
Fourth ventricle neurocysticercosis with hydrocephalus: A case report and literature review
Donato Creatura, Jad El Choueiri, Leonardo Anselmi, Leonardo Di Cosmo, Beatrice Claudia Bono, Angela Dele Rampini, Luigi Alberto Andrea Lanterna
Donato Creatura, Leonardo Anselmi, Beatrice Claudia Bono, Department of Neurosurgery, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Humanitas University, Milan 20089, Lombardy, Italy
Jad El Choueiri, Leonardo Di Cosmo, School of Medicine, Humanitas University, Milan 20072, Lombardy, Italy
Angela Dele Rampini, Luigi Alberto Andrea Lanterna, Department of Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Lombardy, Italy
Author contributions: Creatura D and Lanterna LAA designed the study; Creatura D and Anselmi L collected the clinical data; Creatura D and El Choueiri J wrote the manuscript; Lanterna LAA, Bono BC, and Rampini AD supervised the study and critically revised the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Jad El Choueiri, School of Medicine, Humanitas University, Via Rita Levi Montalcini 4, Milan 20072, Lombardy, Italy. jad.elchoueiri@st.hunimed.eu
Received: December 10, 2025 Revised: March 5, 2026 Accepted: March 30, 2026 Published online: May 6, 2026 Processing time: 138 Days and 14.7 Hours
Abstract
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.
Core Tip: Intraventricular neurocysticercosis (NCC) may present with obstructive hydrocephalus requiring urgent management. Although endoscopic third ventriculostomy can relieve hydrocephalus, it may not address the underlying obstruction caused by the cyst. This case highlights the management dilemma between cerebrospinal fluid diversion and definitive cyst removal in fourth ventricle NCC. When symptoms persist or the lesion enlarges, microsurgical excision through a suboccipital telovelar approach remains a safe and effective treatment strategy.
