Ventriculoscopy combined with Ommaya reservoir implantation for treatment of hydrocephalus with atypical neuroimaging features of neurocysticercosis: A case report.

RATIONALE

Cysticercosis-induced hydrocephalus presents diagnostic and therapeutic challenges owing to its heterogeneous clinical manifestations. Acute hydrocephalus secondary to parasitic infections of the central nervous system (CNS) requires tailored surgical interventions to address impaired cerebrospinal fluid (CSF) dynamics and intracranial hypertension.

PATIENT CONCERNS

A 27-year-old male reported intermittent dizziness and headaches persisting for 3 years and a recent onset of vomiting over the past month.

DIAGNOSES

Neuroimaging demonstrated ventricular enlargement, thickened basal membranes, and elevated intracranial pressure, without classical cysticercosis imaging markers. Serological and CSF enzyme-linked immunosorbent assay (ELISA) tests confirmed the presence of antibodies against cysticercosis. The patient was diagnosed with acute exacerbation of chronic hydrocephalus secondary to a CNS cysticercosis infection complicated by extensive ependymitis and CSF absorption dysfunction.

INTERVENTIONS

Ventriculoscopy identified impaired CSF circulation caused by ependymitis, precluding conventional ventriculoperitoneal (V-P) shunts or endoscopic third ventriculostomy. An Ommaya reservoir was implanted to regulate intracranial pressure, which was supplemented by antiparasitic therapy with praziquantel.

OUTCOMES

Postoperative follow-up confirmed resolution of hydrocephalus and complete alleviation of neurological symptoms, with no complications observed.

LESSONS

This case highlights ventriculoscopy-guided Ommaya reservoir implantation as a safe and effective alternative for managing parasitic infection-induced hydrocephalus when standard surgical options are contraindicated. This strategy addresses both CSF dynamics and infection and provides a reference for managing atypical neurocysticercosis cases.