• Kuntal Kanti Das, Jaskaran Singh Gosal, Suyash Singh, Anant Mehrotra, Awadhesh Jaiswal, Sushila Jaiswal, and Raj Kumar.
• Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. Electronic address: drkuntalkantidas@gmail.com.
• World Neurosurg. 2017 Jun 1; 102: 693.e1-693.e5.

BackgroundIntraventricular and subarachnoid forms represent the relatively complex, albeit uncommon, manifestations of central nervous system involvement by cysticercal cysts. Cysticercal encystation inside the Blake's pouch remnant of mega cisterna magna (MCM) remains an extremely rare clinical scenario that, to the best of our knowledge, has not been reported previously.Case PresentationA 12-year-old boy presented with acute worsening and subsequent spontaneous resolution of his compensated hydrocephalus. Neuroimaging revealed features consistent with a MCM with septum inside, indicating remnants of the embryologic fourth ventricular diverticulum, the Blake's pouch. It also revealed a free-floating intact cysticercal cyst inside the MCM limited by the septum with aqueductal stenosis. The spontaneous clinicoradiologic resolution of hydrocephalus raised the possibility of ball valve obstruction of the cerebrospinal fluid outflow, i.e., Bruns syndrome. We successfully treated this patient with endoscopic extraction of the viable cysticercal cyst through a suboccipital burrhole.ConclusionsThe clinical scenario presented here has not been described previously. Endoscopic cyst removal in such a situation is an effective and low-risk procedure that obviates the further need for antihelminthic medications.Copyright © 2017 Elsevier Inc. All rights reserved.

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