Introduction: The most common parasitic infection of the central nervous system is neurocysticercosis which in 20% of cases is intraventricular, the fourth ventricle being one of the most frequent locations. These lesions cause obstructive hydrocephalus that requires the placement of a ventricle-peritoneal shunt (DVP) whose dysfunction rate is high due to the presence of adhesions and the formation of multiple compartments being the cyst isolated from the IV ventricle one of the most difficult treatment.

Clinical Case: We present the case of a 34-year-old patient with a history of neurocysticercosis who received antiparasitic treatment and the placement of a DVP, presenting multiple dysfunction with severe dilatation of the IV ventricle. It was decided to perform an aqueductoplasty and the placement of a stent in the Silvio aqueduct followed by the placement of a new left frontal DVP, after removing the DVP with parietooccipital “Y” connector and left posterior fossa. Tomographic control at week showed a decrease in ventricular size, catheters in an adequate position, clinical improvement and good patient evolution.

Conclusion: Endoscopic aqueductoplasty with stent placement in the Silvio aqueduct is an effective measure in cases of isolated cyst in the fourth ventricle, achieving good clinical and imaging evolution compared to other therapeutic options.