Spinal Hydatid Cyst Disease : Challenging Surgery - an Institutional Experience

Abstract

ObjectiveHydatid cyst disease is caused by the parasite Echinococcus granulosus. It is rarely seen in the vertebral system, occurring at a rate of 0.2–1%. The aim of this study is to present 12 spinal hydatid cyst cases, and propose a new type of drainage of the cyst. MethodsTwelve cases of spinal hydatid cysts, surgical operations, multiple operations, chronic recurrences, and spinal hydatic cyst excision methods are discussed in the context of the literature. Patients are operated between 2005 and 2016. All the patients are kept under routine follow up. Patient demographic data and clinicopathologic characteristics are examined. ResultsSix male and six female patients with a median age of 38.6 at the time of surgery were included in the study. Spinal cyst hydatid infection sites were one odontoid, one cervical, five thoracic, two lumbar, and three sacral. In all cases, surgery was performed, with the aim of total excision of the cyst, decompression of the spinal cord, and if necessary, stabilization of the spinal column. Mean follow up was 61.3 months (10–156). All the patients were prescribed Albendazole. Three patients had secondary hydatid cyst infection (one lung and two hepatic). ConclusionThe two-way drainage catheter placed inside a cyst provides post-operative chlorhexidine washing inside the cavity. Although a spinal hydatid cyst is a benign pathology and seen rarely, it is extremely difficult to achieve a real cure for patients with this disease. Treatment modalities should be aggressive and include total excision of cyst without rupture, decompression of spinal cord, flushing of the area with scolicidal drugs, and ensuring spinal stabilization. After the operation the patients should be kept under routine follow up. Radiological and clinical examinations are useful in spotting a recurrence.

Echinococcosis of the spine

“… 88 Although variable and combined surgical approaches have been reported, posterior decompression by laminectomy and spinal fusion with or without thoracotomy for thoracic spine echinococcosis is the most common. 24 , 25 , 43 – 46 , 85 , 86 , 89 , 90 The purpose of the surgery is total removal of the cyst without rupture. However, complete clearance is difficult due to the invasive diffuse spread within the bone and the spinal canal.…”

“…Thorough irrigation of the surgical area with hypertonic saline is recommended to prevent recurrences. 47 , 86 , 90 A novel type of drainage of spinal hydatid cyst was proposed by Caglar et al 90 During surgery, the surgeon places a two-way drainage catheter inside the cyst; the distal end catheter is placed outside the patient. Postoperatively, the cyst is injected with chlorhexidine solution (0.04% Chx-Glu).…”

“…However, this method has not been tested in a clinical setting yet and studies should be carried out to verify its efficacy. 90 A palliative surgical operation is considered in patients with extensive disease that cannot be totally excised because of innumerable vertebral cysts. 44 , 46 , 91 …”

“…Recurrence was seen in nine cases (75%). 90 Gezercan et al described eight patients with spinal echinococcosis followed for 7–15 years. All cysts ruptured during surgery and hypertonic saline irrigation was used; no anaphylactoid reaction occurred.…”

Spinal Hydatid Disease of Cervico-Thoracic in Pregnant Women: A Case Report and Review

“…Наиболее частыми вариантами вертебрального поражения являются кистозный (возбудитель -E. granulosus) и альвеолярный (возбудитель -E. multilocularis) [6,7]. Среди отделов позвоночника чаще всего поражается грудной (45-50%), реже вовлекаются пояснично-крестцовый (25-32%) и поясничный отделы (до 15%) [8].…”