Surgical management of brainstem hydatid cyst--an unusual site

Hydatid disease of central nervous system, a clinicopathological study of 33 cases

Objectives

Involvement of central nervous system (CNS) by Hydatid cyst is rare comprising 0.5-4% of all hydatid cysts and principally affecting those younger than 20 years, giving rise to cystic masses mostly in the cerebral hemispheres. To report the clinicopathological findings of CNS hydatid cysts, we diagnosed and review the findings of the previous studies.

Materials and Methods

All cases reported in our Section between January 1, 2001, and June 30, 2022, were included in the study. By searching our files, cases were retrieved, and diagnosis was confirmed. Follow-up was received on telephone. Ethical exemption was obtained.

Results

Thirty-three cases were diagnosed. Almost all were received from rural areas. There were 17 females and 16 males. Mean and median age were 20 and 19 years, respectively. Over 60% were younger than 20 years of age. All 33 involved the cerebral and cerebellar hemispheres. Seventy six percent were supratentorial while 24% were infratentorial. The most common signs and symptoms included weakness, headaches, and seizures. All appeared as solitary cystic masses on imaging. Almost 67% were clinically suspected to be hydatid cysts. Grossly, thin-walled transparent unilocular or multilocular cysts filled with viscous material were received intact in 52% and in multiple pieces in 48% cases. Intact cysts measured 7 cm on average. All demonstrated typical histology. Of the nine patients whose follow-up was available, one died from unspecified acute surgery related complications. Four patients were asymptomatic at the time of follow-up, whereas four developed recurrent cysts. All eight received albendazole therapy.

Conclusion

Cerebellum/posterior fossa location was common. Several cases were received in multiple pieces with increased risk of recurrence. Clinicopathological features were similar to those reported in literature. This series will hopefully serve to increase awareness regarding CNS hydatid disease.

Third ventricle hydatid cyst: A rare case report and review of the literature

A primary intraventricular hydatid cyst is a very rare phenomenon, which is mostly located in the lateral ventricle. To the best of our knowledge, only two cases of third ventricle hydatid cyst have been reported. Herein, we present a very rare case of third ventricle hydatid cyst in a four- year-old boy with nausea, vomiting, and progressive drowsiness. Neuroradiological examination revealed a large, spherical, well-defined cystic lesion within the third ventricle. The patient underwent surgery using the anterior interhemispheric transcallosal approach, and the cyst was successfully removed using the Dowling's technique. In this case report, we described the first case of transcallosal removal of a rare third ventricle hydatid cyst, which can be considered in the differential diagnosis of suprasellar arachnoid cysts. Caution must be taken in determining the best surgical approach to prevent unexpected complications.

Successful Surgical Treatment of a Brain Stem Hydatid Cyst in a Child

Hydatid disease is a parasitic infestation, which is endemic in the Mediterranean region. It is often located in the liver and the lungs, whereas brain stem hydatid cysts are extremely rare. We report a case of a five-year-old female who presented with hemiparesis, and after investigations, she was diagnosed with a hydatid cyst in the pons. She also had cysts in her liver and kidney. The cerebral cyst was completely removed without rupture, using gentle water-jet dissection (Dowling's technique). She was feeling well after 4-month follow-up. We emphasize the importance of keeping hydatid cysts in the differential diagnosis of pediatric infratentorial cystic lesions.

Peripontomedullary hydatid cyst: Case report and literature review

INTRODUCTION

Hydatid cyst represents the parasitic infection by Genus Echenococcus Granulosis. This disease usually involves liver followed by lungs and rarely the CNS. The CNS involvement by the Hydatid Cyst is present in 1-2% of all hydatidosis. Even when it is found in the Brain it presents usually in the supratentorial compartment. However this case was unique in having the Hydatid cyst within the infratentorial fossa. With multiple small cysts, causing mass effect and challenging for surgical resection.

PRESENTATION

A 44 years female presented with headache, diplobia and bulbar symptoms, followed by ataxia. Full examination, proper investigations showed the peripontomedullary hydatid cysts. Surgical management is illustrated.

DISCUSSION

It is still challenging for the neurosurgeons to operate on these lesions in spite of modern technologies and fancy approaches due to its delicate nature, associated risk of allergic reaction, cyst's material dissemination and irreversible injury of multiple neurological structure due to prolonged compression of cranial nerves crossing the cerebellopontine angle.

CONCLUSION

In this case report we are presenting a rare case of Multiple Hydatid cysts involving a rare location in the brain; peripontomedullary area and extending all the way down to the foramen magnum. Supported with a literature review in relation to disease etiology, epidemiology, clinical presentation and management.