Giant intracranial neurocysticercosis mimicking brain tumors: Two illustrative cases with a practical neurosurgical decision-making algorithm

Background: Giant parenchymal neurocysticercosis (NCC) is a rare Taenia solium infection that can mimic neoplasms or cystic lesions. Its appearance, mass effect, and risk of neurological deterioration may complicate diagnosis and management, especially when surgery is considered. Case Description: We present two cases of giant parenchymal NCC initially diagnosed as intracranial neoplasms because of radiological findings and mass effect. Both patients underwent surgery for neurological deterioration and diagnostic uncertainty. In the first case, intraoperative findings suggested NCC, later supported by response to antiparasitic therapy. In the second, frozen section and histopathology confirmed NCC, allowing modification of the oncological procedure and avoidance of extensive resection. Both patients received antiparasitic treatment and had favorable clinical outcomes. Literature review showed that surgery in giant intracranial NCC has been driven by mass effect, neurological deterioration, or diagnostic uncertainty. Conclusion: Giant parenchymal NCC should be included in the differential diagnosis of large cystic intracranial lesions, especially in patients exposed to endemic regions. When findings are inconclusive and deterioration or mass effect is present, surgery may confirm diagnosis and guide further treatment. Intraoperative pathology can avoid unnecessary resection.