PMC6194729_01
(a-c) Axial and Sagittal magnetic resonance imaging views showing a cyst lesion on the left side of the fourth ventricle (a-b). Coronal view showing hydrocephalus with enlarged lateral and third ventricles (c)
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F1
The lesion was hypointense on T1-weighted and T2-weighted MRI sequences and had a peripheral millimetric solid component hyperintense on both sequences [Figure 1].
Another preoperative magnetic resonance imaging was done showing that the location of the cyst changed to the right side of the fourth ventricle
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F2
In this second exam, the lesion showed no contrast enhancement but had changed its location to the contralateral side within the fourth ventricle [Figure 2], revealing its mobile nature.
The postoperative MRI showing a complete cyst removal
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F3
Postop MRI showed a total removal of the cyst lesion and reduction of the ventricle dimensions [Figure 3].
Histopathological examination with haematoxylin and eosin stain showing three distinct layers consistent with a Taenia solium cyst: a cuticular layer with hair-like microtrichia, a middle cellular layer, and an inner reticular layer with focal calcification
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F4
The pathology report confirmed the cyst to be a T. solium larva in its vesicular stage as had already been suspected [Figure 4].
(a-b). Five-week postoperative magnetic resonance imaging showing a pseudomeningocele due to recurrent hydrocephalus (a) with no flow in the previous ventriculostomy (b)
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F5
The MRI showed hydrocephalus recurrence with no evidence of CSF flow through the previous ventriculostomy stoma [Figure 5].
(a-c). Intraoperative imagens showing multiple debris fragments floating in the ventricular space (a, b) and the reopening of the ventriculostomy (c)
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F6
Intraoperatively, we visualized a transparent CSF plenty of floating debris [Figure 6].
(a-b). Postoperative magnetic resonance imaging at 5-month follow-up showing no hydrocephalus or any recurrent or residual cyst
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F7
The 5-month postop MRI ruled out hydrocephalus or any recurrent lesion [Figure 7].