Advances in the management of pineal region neurocysticercosis: A surgical and anatomical study

Background: Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system; however, involvement of the pineal region is exceptionally rare. The scarcity of reported cases and the anatomical complexity of this region make surgical management challenging. We aim to provide an anatomical review, a systematic review of the literature, and an illustrative surgical case to provide a reference for the surgical management of future cases. Methods: An observational, descriptive, and analytical study was conducted, including an anatomical review of the pineal region, a Preferred Reporting Items for Systematic Reviews and Meta-Analyses -guided systematic review of the literature, and the surgical management of a patient with pineal region NCC. Results: The systematic review demonstrated that NCC most frequently involved the cerebral parenchyma (33.91%) and the intraventricular compartment (30.41%), in contrast with the pineal region that accounted for only 0.69% of reported cases. Our illustrative case was managed with endoscopic third ventriculostomy (ETV) for obstructive hydrocephalus, followed by microsurgical resection through a supracerebellar infratentorial approach in the semisitting position. Endoscopic inspection confirmed complete cyst removal. Histopathological examination established the diagnosis of NCC, and the patient had an uneventful post-operative course with complete resolution of hydrocephalus and no procedure-related complications. Conclusion: Pineal region NCC requires individualized surgical management. In selected patients with obstructive hydrocephalus, a staged strategy consisting of ETV followed by microsurgical resection with endoscopic confirmation of complete excision appears to be a safe and effective treatment. This case adds to the limited evidence available and may help guide the management of this rare condition.