Craniocerebral hydatid cyst: Case illustration

Cerebral hydatid cysts are rare, constituting only 2% of all cysts that form in the intracranial space. ^3,4 Combined intracranial–intraos- seous cysts are also extremely rare. ¹

This 5-year-old boy was admitted for progressive right spastic hemiparesis and seizure. There was no history of head injury. A com- puted tomography (CT) scan demonstrated multiple hydatid cysts sit- uated in the left frontotemporal region (Fig. 1). One cyst was extra- dural and manifested thinning and hyperostosis of the internal table.

A large left temporoparietal craniotomy was performed, whereupon it was discovered the first cyst was intraosseous (Fig. 2 left), the sec- ond was attached at the dura mater (Fig. 2 right), and the remaining three cysts were cortical. All were removed without rupture. On dis- charge, the patient was given antiepileptic medication, and he expe- rienced a good recovery. Postoperative CT scans revealed no resid- ual cyst (Fig. 3).

Intracranial hydatid disease can occur in three forms, as reported by Erman, et al. ² The dura mater is an important wall protecting the brain and spinal cord. In the absence of a head injury or a fragile dura (as in meningitis), we cannot explain the pathogenesis of this combined craniocerebral location clearly. The extradural space can be infected by the passage of a scolex or a tapeworm embryo through blood ves- sels, ² by extrusion of intracranial cysts through healthy dura, or by erosion of an osseous hydatid lesion into the extradural space. Com- puted tomography scans are of great value in the identification of cerebral and bone lesions and are helpful in surgical planning. Indeed, the total removal of craniocerebral cysts of this type is more difficult because of their adherence to the dura and bone trabeculae. The most important consideration during operative removal is to prevent spill- age of the contents of the cyst over the exposed brain tissue. ⁵

We conclude that “craniocerebral hydatid cyst” is the appropriate name for this type of lesion. Although the mechanism of pathogene- sis remains unclear, the location is documented. Craniocerebral hy- datid cyst should be included in the differential diagnosis of all crani- ocerebral cystic lesions.

References

1. Canbolat A, Önal C, Kaya U, Çoban TE: Intracranial extradural hydatid cysts: report of three cases. Surg Neurol 41:230–234, 1994

2. Erman T, Tuna M, Göçer I, Ildan F, Zeren M, Çetinalp E: Intra- cranial intraosseous hydatid cyst. Case report and review of the literature. Neurosurg Focus 11(1):Clinical Pearl #1, 2001 3. Kires¸i DA, Karabacakogˇlu A, Ödev K, Karaköse S: Uncommon

locations of hydatid cysts. Acta Radiol 44:622–636, 2003 4. Savas L, Onlen Y, Akcali C, Aslan B, Pourbagher A, Tunc T,

et al: Hydatid disease with atypical localization: 4 cases report.

Scand J Infect Dis 36:613–615, 2004

5. Tuzun Y, Kadioglu HH, Izci Y, Suma S, Keles M, Aydin IH:

The clinical, radiological and surgical aspects of cerebral hyda- tid cysts in children. Pediatr Neurosurg 40:155–160, 2004

J. Neurosurg: Pediatrics / Volume 105 / July, 2006

J Neurosurg (1 Suppl Pediatrics) 105:77, 2006

Craniocerebral hydatid cyst Case illustration

S AID H ILMANI , M.D., A BDERRAZAK B ERTAL , M.D., A BDELHAKIM L AKHDAR , M.D., A LI O UBOUKHLIK , M.D., A BDENABI E LKAMAR , M.D., AND A BDESSAMAD E LAZHARI , M.D.

Department of Neurosurgery, Ibn Rochd University Hospital, Casablanca, Morocco

Key Words • cerebral hydatid cyst • skull • echinococcus • pediatric neurosurgery

77 Manuscript received June 17, 2005; accepted in final form March 28, 2006.

Address reprint requests to: Said Hilmani, M.D., Department of Neurosurgery, Ibn Rochd University Hospital, Casablanca 12003, Morocco.

email: hilmani.said@caramail.com.

F IG . 1. Cerebral CT scan showing the multiple hydatid cysts.

F IG . 2. Left: Perioperative photograph showing bone erosion (arrow in left) and dural invasion by the hydatid cyst (right).

F IG . 3. Postoperative CT scans confirming total cyst removal.