To report 3 cases of intraventricular neurocysticercosis admitted between 2017-2019 to Boston Medical Center that were managed medically without surgical resection.

Intraventricular neurocysticercosis (IVNCC) is highly morbid, and poses a risk of complications including obstructive hydrocephalus and ventriculitis. Current guidelines recommend surgical intervention, however, evidence for this approach remains limited, and in some cases, surgical intervention may not be technically feasible.

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Case 1: A 40-year-old male presented with one week of headaches associated with nausea, vomiting and blurred vision. He was found to have a 4^th ventricular cyst and hydrocephalus on MRI, with a positive cerebrospinal fluid (CSF) Taenia solium antibody. Case 2: 38-year-old female presented with 2 weeks of severe headaches associated with blurry vision, syncopal episodes, nausea and vomiting. She was found to have a cyst adherent to the roof of the 3^rd ventricle causing hydrocephalus. Case 3: A 57-year-old male with a history of previously treated neurocysticercosis presented with increased seizure frequency and a non-focal exam. He was found to have a cyst in the anterior horn of the right lateral ventricle in close proximity to the fornix and suspected adherence to the ventricular wall. Additionally, he also had multiple parenchymal cysts. Surgery to extract the intraventricular cysts was deferred for these patients due to a high risk for neurological damage during the procedure. All three patients were treated with albendazole and praziquantel between 3 and 14 weeks with subsequent cyst involution on MRI. Cases 1 and 2 were complicated by hydrocephalus requiring placement of external ventricular drains (EVDs).

Here, we describe good patient outcomes with non-surgical management of IVNCC. Medical treatment with or without EVD can yield favorable outcomes in non-operable cases of IVNCC. Medical management of IVNCC warrants further investigation, and future guidelines should outline cases where medical management may be the preferred option.