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| LETTER TO EDITOR |
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| Year : 2012 | Volume
: 60
| Issue : 2 | Page : 260-262 |
Partially calcified giant intracerebral hydatid cyst in a pediatric child
Arun Palani
Department of Neurosurgery, Manipal Super-Specialty Hospital, Vijayawada, Andhra Pradesh, India
| Date of Submission | 30-Mar-2012 |
| Date of Decision | 01-Apr-2012 |
| Date of Acceptance | 04-Apr-2012 |
| Date of Web Publication | 19-May-2012 |
Correspondence Address:
Arun Palani
Department of Neurosurgery, Manipal Super-Specialty Hospital, Vijayawada, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.96437
How to cite this article:
Palani A. Partially calcified giant intracerebral hydatid cyst in a pediatric child. Neurol India 2012;60:260-2 |
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
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 | 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
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 | Figure 4: The cut surface of the mass showing a peripheral papillary mass
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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]
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| 5. | Ersahin Y, Mutluer S, Güzelbag E. Intracranial hydatid cysts in children. Neurosurgery 1993;33:219-25.
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| 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.
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| 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.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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