Endoscopic removal of cysticercal cysts within the fourth ventricle

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Abstract
✓ There is no consensus as to the optimum management of patients who harbor cysticercal cysts within the fourth ventricle. Compared with the alternative treatment options of anthelmintic medication and/or cerebrospinal fluid shunt placement, the surgical removal of the cyst has the advantage of eliminating the inflammatory nidus and potentially obviating the need for a complication-prone shunt. Here, an endoscopic surgical approach is described and proposed as an alternative to the standard suboccipital craniectomy for removal of cysticercal cysts within the fourth ventricle.A retrospective analysis of five consecutive endoscopic cases was performed. Endoscopic removal of all cysts within the fourth ventricle was successful in each case. The mean length of operative time was short and blood loss was insignificant. The endoscopic procedure was safe and associated with minimal postoperative discomfort in most patients.In properly selected patients, the endoscopic removal of cysticercal cysts located within the fourth ventricle should be considered as the primary treatment for this condition.