Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 8135  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (787 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed3243    
    Printed53    
    Emailed0    
    PDF Downloaded47    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 2  |  Page : 260-262

Partially calcified giant intracerebral hydatid cyst in a pediatric child


Department of Neurosurgery, Manipal Super-Specialty Hospital, Vijayawada, Andhra Pradesh, India

Date of Submission30-Mar-2012
Date of Decision01-Apr-2012
Date of Acceptance04-Apr-2012
Date of Web Publication19-May-2012

Correspondence Address:
Arun Palani
Department of Neurosurgery, Manipal Super-Specialty Hospital, Vijayawada, Andhra Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.96437

Rights and Permissions



How to cite this article:
Palani A. Partially calcified giant intracerebral hydatid cyst in a pediatric child. Neurol India 2012;60:260-2

How to cite this URL:
Palani A. Partially calcified giant intracerebral hydatid cyst in a pediatric child. Neurol India [serial online] 2012 [cited 2019 Aug 21];60:260-2. Available from: http://www.neurologyindia.com/text.asp?2012/60/2/260/96437


Sir,

Hydatid disease is caused by the larval stage of the different species of the tapeworm Echinococcus (E.granulosus, E.multilocularis, E.vogeli, and E.oligarthus). The most common form worldwide including India, cystic echinococcosis, is caused by E.granulosus. It is endemic in Mediterranean countries, the Middle East, South America, and Australia. In the Indian subcontinent, the disease is endemic in the Kurnool district of Andhra Pradesh, and Tamil Nadu. [1] Brain involvement is rare and occurs in 1-2% of all cases of hydatidosis [2] and cyst calcification occurs in 1-5% of cerebral echinococcosis. [3]

A 12-year-old girl child, a diagnosed case of patent ductus arteriosus, presented with history of headache and progressively increasing weakness of right-sided limbs of three months. There was history of contact with stray dogs. Neurologic examination revealed early papilledema and right hemiparesis (4/5 power). Computed tomography (CT) scan of brain [Figure 1] showed a large cystic mass, 7 × 6 × 6 cm in size in the left parietal region with an area of calcification in the postero-superior wall. The magnetic resonance imaging (MRI) confirmed the findings [Figure 2]. With the preoperative diagnosis of hydatid cyst, she was operated on by a left fronto-parietal craniotomy and the cyst [Figure 3] was excised in toto using Dowling's technique. [4] The postero-superior wall of the cyst was found to be slightly adherent to the adjacent parenchyma during the procedure. The cut surface showed a peripheral papillary area [Figure 4] which was confirmed histopathologically as an immune reaction with calcification. Postoperatively the child was put on albendazole (10 mg/kg twice daily for three months). She recovered well without any fresh deficits.
Figure 1: CT brain axial sections showing a large cystic mass in the parietal region reaching up to the cortical surface, with peripheral calcification in the postero-superior wall

Click here to view
Figure 2: MRI brain T1 (2a) and T2 (2b)-weighted images showing the cystic mass with hypointensity in the postero-superior wall consistent with calcification

Click here to view
Figure 3: Pearly white cystic mass noted after opening dura

Click here to view
Figure 4: The cut surface of the mass showing a peripheral papillary mass

Click here to view


Intracranial hydatid disease is rare and is more common in the pediatric population, probably related to a patent ductus arteriosus. [2],[5] The most common location of the cyst is in the middle cerebral artery territory. [6] They are asymptomatic until they reach a certain size. The growth has been variably reported as 1.5-10 cm per year. [7] The calcification in a hydatid cyst is usually ring-like with a curvilinear pattern and develops in the pericyst consisting of modified host cells and a fibrous protective zone. It develops in all the components of the cyst during the natural healing stage once the pericyst is calcified. [8] In this child the findings were similar with a peripheral papillary growth and calcification. Partial calcification of the pericyst does not indicate death of the parasite. [6]

Treatment of cerebral hydatid cysts is primarily surgical, total cyst extirpation without rupture. [2] Many different techniques of cyst removal have been proposed and all of them emphasize atraumatic techniques to avoid cyst rupture. The Dowling technique [4] has been widely used for the surgical treatment of hydatid cysts of the central nervous system. Accidental rupture of the cyst with spillage of live scolices during the surgical procedure may result in severe anaphylaxis, and late recurrence of the disease. Hypertonic saline and formalin have been injected in the cyst in an effort to control this risk, but with variable success. [9] Although the principal treatment is surgery, pre- and postoperative administration of albendazole may be considered to sterilize the cyst, decrease the chance of anaphylaxis, decrease the tension in the cyst wall, and reduce the recurrence rate. [1]

 
  References Top

1.Reddy DR. Managing cerebral and cranial hydatid disease. Neurol India 2009;57:116-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Tuzun Y, Kadioglu HH, Izci Y, Suma S, Keles M, Aydin IH. The clinical, radiological and surgical aspects of cerebral hydatid cysts in children. Pediatr Neurosurg 2004;40:155-60.  Back to cited text no. 2
    
3.Abderrahmen K, Aouidj ML, Kallel J, Khaldi MM. Calcified cerebral hydatid cyst. Neurochirurgie 2007;53:371-4.  Back to cited text no. 3
    
4.Carrea R, Dowling E Jr, Guevera A. Surgical treatment of hydatid cysts of the central nervous system in the pediatric age (Dowling's technique). Childs Brain 1975;1:4-21.  Back to cited text no. 4
    
5.Ersahin Y, Mutluer S, Güzelbag E. Intracranial hydatid cysts in children. Neurosurgery 1993;33:219-25.  Back to cited text no. 5
    
6.Pedrosa I, Saiz A, Arrazola J, Ferreiros J, Pedrosa CS. Hydatid disease: Radiologic and pathologic features and complications. Radiographics 2000;20:795-817.  Back to cited text no. 6
    
7.Sierra J, Oviedo J, Bertheir M, Leiguarda R. Growth rate of secondary hydatid cysts of the brain. J Neurosurg 1985;62:781-2.  Back to cited text no. 7
    
8.Köktekir E, Erdem Y, Gökcek C, Karatay M, Yilmaz A, Bayar MA, et al. Calcified intracranial hydatid cyst: Case report. Turkiye Parazitol Derg 2011;35:220-3.  Back to cited text no. 8
    
9.Siraj MU, Haq MU, Imran M. A giant intracranial hydatid cyst excised in toto: Case report and review of literature. Anaesth Pain Intensive Care 2010;14:112-4.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow