Views on the management of intracranial hydatid disease

Abstract AR

Background & Objective: To study the main clinical presentation and radiological findings in patients with intracranial hydatid disease and to discuss surgical treatment and outcome.

Methods : This study consisted of 31 patients who were surgically managed at the Neurosurgical Unit, Mosul Teaching Hospital between January 1992 and December 2001.

A retrospective analysis of the case records, investigations, radiological examinations, operative findings and follow-up was done.

All cases were investigated by CT of the brain and more recently by MRI.

Chest x-ray and ultrasound of the abdomen and pelvis were utilized to diagnose systemic hydatid disease.

All patients underwent craniotomy and cyst removal.

Follow-up of these patients ranged from 2 to 8 years.

Results: There were 12 males and 19 females with ages ranging between 2.5 and 34 years.

The main presentations were raised intracranial pressure in 29 (93%) and hemiparesis in 27 (87%) patients.

The mean duration from the first complaint to diagnosis was 5 months.

Twenty-three (74%) patients had solitary and 8 (26%) patients had multiple cysts.

In 93% of the cases, the cysts were located in the supratentorial compartment in the territory of middle cerebral artery.

In 26 (84%) of the patients, the cysts were removed intact.

All but one patient recovered uneventfully.

Post-operative complications were transient and included: wound infection, CSF leak, meningitis and hemiparesis.

Recurrence was noticed in three patients.

Conclusion: Cerebral hydatid disease usually presents as a space-occupying lesion and is usually located supratentorially.

The predominant signs seen include intracranial hypertension and hemiparesis.

In all but one patient, proper preoperative diagnosis was achieved depending on CT and MRI studies.

Radical surgery is always indicated in cerebral hydatid cyst.

The surgical challenge is to remove the cyst unruptured.

If removed intact, these cysts are usually associated with minimal morbidity and low mortality.