2026 Poster Presentations
P013: MICROSURGICAL RESECTION OF RACEMOSE NEUROCYSTICERCOSIS IN THE THIRD VENTRICLE: A RARE CAUSE OF INTRACRANIAL HYPERTENSION
Eliza Maria Bertolaccini Scolin; Bruno Dias Melo; Paulo José da Mata Pereira; Paulo Niemeyer Soares Filho; Instituto Estadual do Cérebro Paulo Niemeyer
Introduction: Neurocysticercosis represents the most prevalent parasitic infection of the central nervous system, particularly in Latin America, sub-Saharan Africa, and parts of Asia. The racemose variety of NCC and it’s caused by the larval form of Taenia solium and is an severe form, characterized by multiloculated cysts, typically devoid of a visible scolex, and preferentially located in the subarachnoid and intraventricular spaces, and frequently leading to hydrocephalus and requiring surgical treatment. MRI remains the gold standard for diagnosis, enabling detailed characterization of cyst morphology and location.
Objective: To report a case of racemose neurocysticercosis in the third ventricle causing hydrocephalus, successfully managed through a neuronavigation-guided microsurgical approach in the absence of ventricular endoscopy.
Methods: A 52-year-old man from Ceará, Brazil, presented with a one-year history of daily holocranial headaches responsive to analgesics, along with new-onset generalized tonic-clonic seizures, effectively controlled with levetiracetam 1 g/day. Neurological examination was unremarkable. Brain MRI revealed a multiloculated cystic lesion within the third ventricle, isointense to CSF, with posterior extension into the interpeduncular cistern, causing supratentorial hydrocephalus. Surgical intervention was performed via a neuronavigation-guided transulcal transforaminal approach through the inferior frontal sulcus. Intraoperatively, multiple whitish vesicular structures were identified within the third ventricle. Histopathological examination confirmed racemose neurocysticercosis.
Results: Postoperative treatment included albendazole (1.2 g/day for 14 days) and dexamethasone. The patient had complete resolution of headaches and remained seizure-free on levetiracetam (1 g/day). Follow-up imaging showed no residual cysts and resolution of hydrocephalus with improve of headache and no recurrence ofseizures under continued levetiracetam.
Conclusion: This case underscores the importance of considering racemose NCC in patients from endemic areas presenting with obstructive hydrocephalus and seizures. When neuroendoscopic equipment is unavailable, a neuronavigation-guided microsurgical approach offers a safe and effective alternative for lesion removal, optimal outcomes require a comprehensive approach combining antiparasitic agents, corticosteroids, and symptomatic treatment.