Transventricular neuroendoscopic excision of giant racemose subarachnoid cysticercosis

Subarachnoid cysticercosis, an uncommon form of neurocysticercosis, can occasionally grow to giant size causing mass effect and obstructive hydrocephalus. These often require surgical excision to relieve the mass effect and re-establish the cerebrospinal fluid (CSF) pathways. The authors report a rare case of giant anterior interhemispheric racemose cysticercosis with extension to the region of septum pellucidum causing obstructive hydrocephalus. Due to the proximity of the cysts to the dilated ventricular system, a frontal transventricular endoscopic approach was preferred over a conventional microsurgical or endoscopic-assisted microsurgical approach. Most of the cysts could be successfully resected from the region of septum pellucidum and the anterior interhemisphere. The patient did not require a CSF diversion procedure in the postoperative period. Depending on the location and nature of the lesion, a transfrontal transventricular endoscopic approach can be successfully utilized to approach lesions in the anterior interhemispheric region.