A hidden traveler in the brain: A 19-year odyssey of migratory cerebral sparganosis.

Background: Cerebral sparganosis is a rare parasitic infection of the central nervous system caused by the plerocercoid larva of Case Description: We report a rare case of cerebral sparganosis with an exceptionally prolonged disease course of 19 years. The patient initially presented with seizures and underwent a stereotactic brain biopsy; however, a definitive diagnosis could not be established at that time. Serial magnetic resonance imaging revealed a unique and extensive intracerebral migratory pattern, including deep-seated and eloquent areas. Eventually, the parasite migrated to a surgically accessible cortical location, allowing for successful resection. Histopathology confirmed a degenerated Sparganum larva surrounded by chronic inflammation. A schematic diagram was created to illustrate the complex migratory pathway. A literature review of cases lasting ≥10 years was also conducted, highlighting the parasite's exceptional longevity and treatment outcomes. Conclusion: This case highlights the remarkable ability of Sparganum larvae to survive within human brain tissue for nearly two decades, with evidence of active intracerebral migration. Surgical excision remains the most definitive and effective treatment approach. Due to the potential for delayed diagnosis and chronic progression, long-term imaging follow-up and continued clinical awareness are essential for early recognition and successful management, even in regions where sparganosis is not commonly encountered.