Primary paraspinal hydatid cyst treated with puncture, aspiration, injection and re-aspiration (PAIR) technique: a case report

Bïlgïç, Serkan; Köse, Özkan; Şehirlioğlu, Ali; Safaz, İsmail; Özkan, Hüseyin

doi:10.1007/s00586-008-0737-3

Cited by 20 publications

(20 citation statements)

References 13 publications

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“…For muscular HC treatment, en bloc resection is recommended before the rupture and spread of daughter cysts [3,5] . The puncture-aspiration-injectionre-aspiration (PAIR) technique, which was developed as an alternative to surgical excision of liver HC, involves the removal of the contents of HC by means of USG, injection of scolecidal agents, such as 95% ethanol, and re-aspiration of the cyst contents [26,27] .The use of percutaneous drainage with or without re-aspiration (PAIR) in HC treatment was indicated, in particular, for cases which are inoperable or for patients who rejected surgery [6,7,28,29] . Albendazole treatment is recommended to prevent contamination by needle aspiration [6] .…”

Section: Discussionmentioning

confidence: 99%

“…In muscular HC treatment, en bloc resection and albendazole treatment are recommended as first line treatment [5] . The protocols for treating muscular HC by discharging the cyst with the percutaneous needle aspiration technique have been previously defined [6,7] . Our study aims at presenting the result of the treatment we applied and the percutaneous needle aspiration method in treating a primary HC case located between the gastrocnemius and soleus muscles in the cruris posterior, which caused circulation disorders in the patient's lower extremity.…”

Section: Introductionmentioning

confidence: 99%

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An unusual cause of circulatory disorder due to a rare intermuscular hydatid cyst of cruris: A case report

Balioğlu

Gök

Özcan

et al. 2015

CRCP

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Echinococcus granulosus with primary muscular involvement is difficult to diagnose and treat, as it is rarely observed. It may lead to an acute clinical presentation that is occasionally confused with peripheral circulatory disorder findings due to pressure impacts. A 48-year-old male patient has applied to our clinic with severe pain of the right cruris and circulatory disorder that is caused by the compressive effect of the extensive intermuscular cystic lesion surrounded by the septa between the gastrocnemius and soleus muscles. The cyst was carefully drained with needle aspiration, under the guidance of ultrasonography both for histopathological diagnosis and to reduce the compressive impact of the mass. Echinococcus granulosus was identified by histological and pathological inspection. Albendazole was administered daily 400 mg (2×1). After four weeks of treatment, the cyst, together with its capsule, was surgically removed and the patients recovered clinically. Prior to mass excision of the cyst, percutaneous needle aspiration increases the efficacy of medical and surgical treatment, and may be recommended in suitable cases in order to mitigate the risk of recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An unusual cause of circulatory disorder due to a rare intermuscular hydatid cyst of cruris: A case report

Balioğlu

Gök

Özcan

et al. 2015

CRCP

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“…The intraspinal cyst formation was located between the stretched dural sac and the vertebral bodies of the kyphotic apex causing significant compression of the cord (Figs. 2,3,4). A progressive neurologic deficit was reported by the patient.…”

mentioning

confidence: 83%

“…The so-called ''PAIR'' approach (puncture, aspiration of the cyst, injection of hypertonic saline and re-aspiration) is a widely used non-surgical technique for the treatment of hepatic hydatid cysts. Ultrasonography guided PAIR technique has been also used for the treatment for paraspinal manifestation [3]. Potential complications of this technique are anaphylaxis and the risk of iatrogenic spreading.…”

Section: Rationale For Treatment and Evidence-based Literaturementioning

confidence: 99%

Severe kyphoscoliosis after primary Echinococcus granulosus infection of the spine

Thaler

Gabl²,

Lechner

et al. 2010

Eur Spine J

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A primary Echinococcus granulosus infection of the spine involving the vertebrae T8 and T9 of a 6-year-old child was treated elsewhere by thoracotomy, partial corporectomy, multiple laminectomies and uninstrumented fusion. Owing to inappropriate stabilization, severe deformity developed secondary to these surgeries. X-rays, CT and MRI scans of the spine revealed a severe thoracic kyphoscoliosis of more than 100° (Fig. 1) and recurrence of Echinococcus granulosus infection. The intraspinal cyst formation was located between the stretched dural sac and the vertebral bodies of the kyphotic apex causing significant compression of the cord (Figs. 2,3,4). A progressive neurologic deficit was reported by the patient. At the time of referral, the patient was wheelchair bound and unable to walk by herself (Frankel Grade C). Standard antiinfectious therapy of Echinococcus granulosus requires a minimum treatment period of 3 months. This should be done before any surgical intervention because in case of a rupture of an active cyst, the delivered lipoprotein antigens of the parasite may cause a potentially lethal anaphylactic shock. Owing to the critical neurological status, we decided to perform surgery without full length preoperative antiinfectious therapy. Surgical treatment consisted in posterior vertebral column resection technique with an extensive bilateral costotransversectomy over three levels, re-decompression with cyst excision around the apex and multilevel corporectomy of the apex of the deformity. Stabilisation and correction of the spinal deformity were done by insertion of a vertebral body replacement cage anteriorly and posterior shortening by compression and by a multisegmental pedicle screw construct. After the surgery, antihelminthic therapy was continued. The patients neurological deficits resolved quickly: 4 weeks after surgery, the patient had Frankel Grade D and was ambulatory without any assistance. After an 18-month follow-up, the patient is free of recurrence of infection and free of neurologically deficits (Frankel E). This case demonstrates that inappropriate treatment-partial resection of the cyst, inappropriate anterior stabilization and posterior multilevel laminectomies without posterior stabilization-may lead to severe progressive kyphoscoliotic deformity and recurrence of infection, both leading to significant neurological injury presenting as a very difficult to treat pathology.

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“…Both had excellent literature discussions. The two case reports dealing with hydatid disease were of interest, one dealing with total excision of an intra-dural extra-medullary hydatid cyst, and one dealing with aspiration of a cyst within muscle and injection with albendazole [5,8]. In view of the absence of any bone involvement in the first case, one wonders whether the technique of aspiration used with such success in the second case might have been applicable.…”

Section: Introductionmentioning

confidence: 99%

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2010

Mulholland

2011

Eur Spine J

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Primary paraspinal hydatid cyst treated with puncture, aspiration, injection and re-aspiration (PAIR) technique: a case report

Cited by 20 publications

References 13 publications

An unusual cause of circulatory disorder due to a rare intermuscular hydatid cyst of cruris: A case report

An unusual cause of circulatory disorder due to a rare intermuscular hydatid cyst of cruris: A case report

Severe kyphoscoliosis after primary Echinococcus granulosus infection of the spine

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2010

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