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•Awake microsurgical management of brain aneurysms appears to be tolerated for select cases.•Current evidence is limited and stems from observational studies.•Further research is warranted to assess judiciously its safety and preference over existing methods for intraoperative neurological monitoring.

Posterior communicating artery (PCoA) aneurysms represent approximately 15% to 25% of intracranial aneurysms and carry an estimated risk of rupture of 44%.1-4Surgical clipping of PCoA aneurysms bears notable challenges associated with operating in a confined space with limited visualization of deep structures.1,5We illustrate the case of a 54-year-old woman who presented with a seven-hour course of intense headaches, vomiting and loss of consciousness. Her neurological examination revealed she had a 4/5 left-sided hemiparesis, a Glasgow coma scale score of 12, and a Hunt and Hess score of 3. A head computed tomography scan without contrast showed subarachnoid hemorrhage in the basal cisterns and Sylvian fissures (Fisher grade 3). Digital subtraction angiography and three-dimensional reconstruction imaging revealed a right bilobed saccular PCoA aneurysm of 4.8 × 5.9 mm projecting anterior-inferiorly. After consideration of her clinical course and aneurysmal features, she underwent a right minipterional craniotomy for exoscopic clipping of the aneurysm neck. The patient tolerated the procedure well, her hemiparesis improved, and she was discharged with a modified Rankin scale score of 1 on postoperative day 3.Exoscopy offered high image quality and expanded 3-dimensional view with digital zoom during the aneurysm repair.6,7Although evidence suggests exoscopy is non-inferior to microscopy regarding surgery duration, safety, and outcomes, the capability of providing operator ergonomy during surgery is a worth-noting advantage.8IRB and patient consent declaration: This study was exempt from the Institution Review Board because patient consent was granted for the use of clinical information, images, and operative videos.The patient consented to the procedure, and the participants and any identifiable individuals consented to publication of his/her image.

Hydatid disease is an accidental parasitosis, with brain location being rare. The case is reported of a 33-year-old male, with no history of note, who was admitted to hospital with intracranial hypertension syndrome and right hemiparesis. Computed tomography showed a cystic lesion in the left frontal-parietal lobule. Surgery was performed by complete excision of the lesion, with a good outcome. Hydatid disease is a rare condition in the brain. Clinical suspicion is important for an early diagnosis. A review is presented on the pathogenesis, diagnosis and treatment of cerebral hydatid disease.

En la actualidad la hidatidosis es una parasitosis accidental, siendo su ubicación cerebral rara. Presentamos el caso de un varón de 33años que llega a emergencias por síndrome de hipertensión endocraneana y focalización derecha. La tomografía computarizada mostró una lesión quística frontoparietal izquierda, la cual es intervenida quirúrgicamente, realizándose la exéresis completa de la lesión con buena evolución posterior. La hidatidosis es una patología poco frecuente a nivel cerebral, por lo que es importante la sospecha clínica para orientar los estudios al diagnóstico precoz. Revisamos la patogenia, el diagnóstico y el tratamiento de la hidatidosis cerebral.