Intraventricular neurocysticercosis involving the fourth ventricle is a distinct and surgically significant presentation of CNS cysticercosis. The location of the cysts within the fourth ventricle determines both the risks of obstruction and the approach to management.
Cysticerci located within the fourth ventricle — a form of intraventricular neurocysticercosis — present specific management considerations. When surgical removal of these cysts is feasible, evidence supports a procedural approach over medical therapy or cerebrospinal fluid shunting alone.
When fourth ventricular cysticerci are surgically accessible, cyst removal is the recommended first-line approach. The procedural technique used depends on available expertise. Perioperative adjunctive measures are also part of the management.
DOI: 10.1093/cid/cix1084
In cases in which surgical removal of fourth ventricular cysticerci is possible, we recommend surgical removal rather than medical therapy and/or shunt surgery (strong, moderate).
Either endoscopic or microsurgical cystectomy is suitable, depending on the experience of the surgeon.
We recommend corticosteroids to decrease brain edema in the perioperative period (not graded).
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