Hydatid cyst of the cavernous sinus
Yticel K a n p o l a t * , T a n s u Mertol*, Z e k i ~ekerci*, a n d F a t i h Krkew
Introduction
Cerebral hydatid cysts represent approximately 2% of all cases of hydatid infestation. Reports on rare locations of cerebral hydatid cysts have been increasing because of easy application of CT scanning 1,2. To our knowledge, a hydatid cyst has not been described in the carvernous sinus so far.
Case report
A 22-year-old female patient was admitted to our hospital on August 17, 1982, with a four- month history of headache and nausea. The on- ly abnormalities on examination were severe bilateral papilledema with mild stiffness of the neck and left hemiparesia. A CT-scan showed a round cystic tumor with a well defined border in the right parieto-occipital region. The patient underwent a right parieto-occipital craniotomy on August 20, 1982 and a hydatid cyst was re- moved unruptured, by means of constant saline irrigation around the cyst wall.
The patient was well until the second admis- sion except for blurring vision. On December 22, 1983 she was admitted again with a com- plaint that her left eyelid was drooping. A neur- ological examination revealed that she had a complete ophthalmoplegia on the left side. The optic discs were atrophic and visual acuity was 2/10 in the right eye and 1/10 in the left eye. The CT scan demonstrated a cystic lesion in the left cavernous sinus (Fig. 1A), and a right parietal
Summary
A case of hydatid cyst in the cavernous sinus is reported. The cyst was treated by cyst aspira- tion and formalin injection.
Key words: Cerebral hydatid cyst, CT, Ca- vernous sinus, Echinococcus.
low-density area where the first cyst had been located (Fig. 1B). On January 19, 1984 a left pterional craniotomy was performed. Following the exposure of the left parasellar area, a fluctu- ating and bulging mass was seen underneath the dura. The left cavernous sinus was punctured with a fine needle. Clear straw-coloured cyst fluid was aspirated, and while the surrounding cortex was being protected with cottonoid, 10%
formalin was slowly injected. Leaving the for- malin 5 minutes in the cavity, the fluid was evac- uated and thorough washing with saline was applied.
The postoperative course was uneventful and the patient was discharged on the 15th post- operative day. Radiotherapy was recommended and a total dose of 800 R was given. On control examinations carried out in the 3rd and 12th postoperative months, the left ptosis had im- proved, but restriction of ocular movements re- mained unchanged.
* Department ofneurosurgery, University of Ankara, School of Medicine, Ankara, Turkey.
Address for correspondence and reprint requests: Yiicel Kanpolat, Inklldp Sokak No: 24/2, Ktztlay, Ankara, Turkey.
Accepted 7.3.88
Clin Neurol Neurosurg 1988. Vol.90-2. 175
Fig. la.
Computerized tomography scan showing a cystic lesion in the left cavernous sinus.
Fig. lb.
At the upper slide CT scan demonstrating a right parietal low density area where the first cyst was located.
Discussion
Cerebral hydatid cysts are usually single and supratentorial, and tend to occur in the distribu- tion of the middle cerebral arteries. Skull 3:, posterior fossa s, intraventricular 1,6 intrasellar 7 and pontine hydatid cyst locations 8 have been r e p o r t e d as rare.
With increased availability of CT scanning, reports on rare locations of hydatid cysts have gradually increased. Classically CT findings de- scribe hydatid cysts as round or oval, homoge- neous, hypodense areas with a density close to that of the cerebrospinal fluid and with regular contours ~,2. In some cases, there is contrast en- hancement at the level of the periphery of the cyst probably due to compression of the sur- rounding parenchyma.
Successful operative treatment of hydatid cyst depends upon its location and upon complete removal of the unruptured cyst. It can best be achieved by forcing saline solution around and beneath the cyst 3. Although the hazards of con-
tamination resulting from the puncture of the cyst have been known, in the cavernous sinus radical extirpation of the cyst was thought to be impracticable. For this reason, we preferred tapping of the cyst and injection of formalin to the removal of it. Fortunately, the patient made a good recovery.
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