Primary cerebral echinoccocosis in a child: Case report - Surgical technique, technical pitfalls, and video atlas

Abstract

Background:Hydatid disease is a life-threatening parasitic infestation caused by Echinococcus granulosus. Infection with E. granulosus typically results in the formation of hydatid cysts in the liver, lungs, kidney, and spleen. Primary intracranial hydatid cyst disease is extremely rare. Here, we are reporting an unusual case of Echinococcus, where the only identifiable lesion was a hydatid cyst in the brain without liver or lung involvement. We are also providing a description for the surgical technique used to remove the cyst, highlighting the possible surgical pitfalls.Case Description:The patient is a 13-year-old male with a history of progressive headache for 1 month. Intracranial hydatid cyst was suspected based on computed tomography and magnetic resonance imaging findings. The cyst was delivered without rupture using hydrostatic dissection (Dowling's technique), and pathological analysis confirmed the diagnosis. Postoperatively, the patient showed marked neurological improvement and all signs and symptoms resolved.Conclusion:Intracranial hydatid cyst is very rare. Nevertheless, it should always be considered as a differential diagnosis in cerebral cystic lesions, especially in children. The surgical technique used to remove the cyst appears to be safe. However, several precautions must be applied intraoperatively to avoid the catastrophe of cyst rupture.

A Case Report of Primary Brain Hydatid Cyst in a Child

“…Non-contrast CT scans display hypodense, well-circumscribed, and circular cysts compared to the brain tissue. The perilesional edema and enhancement of contrast seen with abscesses or cystic tumors are unusual for brain hydatid cysts [11]. MRI displays brain hydatid cysts as hypo-intense on T1 weighted image, and it appears as a hyper-intense region on T2 weighted image with a hypointense disc surrounding the cyst.…”

“…Excellent peripheral enhancement accompanying perilesional edema may be present in active inflammation, although calcifications are only seen in 1% of the cases. Though, alveolar hydatid appear as a contrast-enhancing solid cystic lesion with perilesional edema, and calcification [11]. Measuring reliable markers such as alanine, succinate, acetate and lactate on Magnetic Resonance Spectroscopy (MRS) before and after treatment is an excellent indicator of efficient chemotherapy [2].…”

Concurrent brain and lung hydatid cyst in a paediatric patient: Anaesthetic challenges

“…Inadvertent cyst rupture requires washing the cavity with hypertonic saline. [ 4 ] The anaesthesiologist's role lies in comprehensive preparation, prompt detection and early aggressive therapy with crystalloids and intravenous epinephrine with the administration of 100% oxygen. We were prepared with all the emergency drugs to manage any such crisis.…”