Surgical management of cerebral peduncle neurocysticercosis
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A 65-year-old man with no medical history complained of headache and progressive right-sided hemiparesis for one month prior to admission. He had no nausea, vomiting, and blurred vision. On examination, he was alert and oriented. His vital signs were normal. He had no intracranial hypertension and meningismus. On the right side, his muscle strength was 3/5 (Frankel grade) with positive Hoffmann and Babinski`s signs. Patellar and biceps reflexes were increased. On the left side, his motor and sensory examination were normal. The fundoscopic examination was normal. He denied cranial nerve palsies.

Magnetic resonance imaging (MRI) of his brain showed a 29?x?18?mm, regular, oval thin-walled cyst located at the left cerebral peduncle and hypothalamus region. It was hypointense on T1W and hyperintense on T2W. Inside of the cyst, a superior posterior mass was not contrast-enhancing on gadolinium-enhanced T1W and had restricted diffusion on diffusion-weighted imaging (DWI). On perfusion sequences, the cyst was not hypervascular. On magnetic resonance spectroscopy (MRS), there was no change in levels of Choline and N-Acetyl Aspartate.

Ppreoperative diagnosis was cystic brain tumors (pilocytic astrocytoma, hemangioblastoma, or dysembryoplastic neuroepithelial tumor). Differential diagnoses were neuroglial cyst and neurocysticercosis. The operation was performed to remove the cyst and examine its pathology. The modified frontotemporal-orbitozygomatic (FTOZ) craniotomy and transsylvian approach were chosen. After opening the dura, surgeons exposed a regular, oval thin-walled cyst measuring 1?x?2?cm with clear fluid in the left frontal lobe. They continued dissecting Sylvian fissure to approach the cerebral peduncle. The cerebral peduncle cyst measuring 2?x?3?cm was also well-circumscribed, thin-walled, and intraparenchymal. There was a solid nodule inside the cyst. Both the cysts were extirpated. Histopathological examination revealed the larva of Taenia solium.Postoperatively, the patient was given Cefoperazone 4?grams per day for five days. The hemiplegia was gradually relieved. The patient was discharged after a week. At a three-month postoperative follow-up, the MRI showed no remnant mass, and his muscle strength was fully recovered.