Kystes hydatiques cérébraux de l’enfant: à propos de 15 cas

Abstract

L’objectif de notre étude est d’illustrer l’intérêt de l’imagerie en coupe (TDM, IRM) dans le diagnostic positif et le suivi post-thérapeutique du kyste hydatique cérébral chez l’enfant et de mettre en lumière les particularités et les difficultés rencontrées dans la prise en charge de la localisation cérébrale de cette affection, par notre expérience basée sur 15 cas de kyste hydatique cérébral de l’enfant. Il s’agit d’une étude rétrospective de 15 cas d’hydatidose cérébrale de l’enfant colligés sur une période de 10 ans. La TDM cérébrale en coupes axiales de 5 mm d’épaisseur sans et avec injection de produit de contraste a été réalisée chez 15 patients. L’IRM encéphalique a été réalisée en séquences pondérées en T1 et en T2 chez un patient dans les trois plans de l’espace sans injection de Gadolinium. L’âge moyen de nos patients était de 9 ans. La symptomatologie clinique était dominée par le syndrome d’hypertension intracrânienne. Le kyste hydatique était solitaire et se situait au niveau de l’étage sus-tentoriel avec un important effet de masse sur le système ventriculaire et la ligne médiane dans la majorité des cas. Tous nos patients ont été opérés et l’évolution était favorable dans tous les cas. La TDM représente l’examen de choix pour le diagnostic et le suivi postopératoire du kyste hydatique cérébral. L’IRM trouve son intérêt essentiellement dans le diagnostic des formes multiples et des formes atypiques permettant une planification thérapeutique plus adaptée.Our study aimed to highlight the role of cross sectional imaging techniques (CT, MRI) in positive diagnosis and post-therapeutic follow-up of cerebral hydatid cysts in children as well as to describe the peculiarities and the difficulties encountered in the management of these cysts based on our experience about 15 cases. We conducted a retrospective study of 15 cases of cerebral hydatidosis in children whose data were collected over a period of 10 years. CT scan of the brain with 5 mm slice thickness without and with injection of contrast product was performed in 15 patients. One patient underwent brain MRI creating either T1-weighted or T2-weighted images in all three planes without Gadolinium injection. The average age of patients was 9 years. Clinical symptoms were dominated by intracranial hypertension syndrome. Hydatid cyst was solitary and was located in the supratentorial level with an important mass effect on the ventricular system and the median line in most cases. All patients underwent surgery and patients’ evolution was favorable in all cases. CT scan is the test of choice for the diagnosis and the postoperative follow-up of patients with cerebral hydatid cysts. MRI is used essentially in the diagnosis of multiple and atypical type of cerebral hydatid cysts, enabling the design of more effective treatment strategy.

Cerebral Hydatitosis: About 12 Observations at the University Hospital Center of Conakry

“…Classically, cerebral hydatidosis is found in children and adults, [3,5], a result that we find in this study.…”

“…Work on hydatidosis shows that in countries with recognized endemicity, hepatic localization accounts for 50% and pulmonary 36%, whereas cerebral sites are only 2% [2]. The data in the literature [3,5,6] show that cysts are mostly found in the supratentorial and subcortical hemispherical zones mainly involving the vascularization zones of the middle cerebral artery, as demonstrated by our series.…”

“…Most authors [2,5,10] believe that magnetic resonance imaging, by showing a low signal in T1 and high signal in T2, is especially indicated in the demonstration of the multiple hydatid cysts and the lesions of the neighboring structures helping thus the surgical act.…”

“…This pathology causes hepatic, pulmonary and cardiac complications, of which cerebral localizations represent 1 to 2% of hydatid cysts in the human body [1,2,5]. In tropical environments, the difficulties of biological diagnosis and inaccessibility to neuroimaging lead us to report only isolated cases of truly documented hydatidosis [3].…”

Hydatid disease among adults and children: it is time to worry!

“…Cerebral HC, a rare disease, doesn't exceed 2 % of the cases and is more frequent in children and young adults, representing 50 to 70% of the cases. However, all ages can be affected (5,6). We noted 2 cases of cerebral HC, which were both among children.…”