[Cerebral hydatid disease: report of six pediatric cases]. / Hidatidosis cerebral: comunicación de seis casos pediátricos.

Hydatid disease is a parasitic infection whose etiologic agent is Echinococcus granulosus. Human is an accidental intermediate host and the most common site is the liver. The brain involvement is unusual and up to 75% of cases are described in the pediatric population. We present six children with cerebral hydatid disease admitted to the Pediatric Hospital J.P. Garrahan. All had neurological involvement on admission. The images showed single cystic lesion in the brain. They did not present involvement in other organs. Serology was negative in all cases. Medical and surgical treatment in all cases. The clinical outcome was favorable without sequelae in five of them and one had a residual paresis right faciobrachiocrural. This infection should be considered in the differential diagnosis of cystic tumor lesions of the central nervous system.

Hidatidosis cerebral: comunicación de seis casos pediátricos / Cerebral hydatid disease: report of six pediatric cases

Hydatid disease is a parasitic infection whose etiologic agent is Echinococcus granulosus. Human is an accidental intermediate host and the most common site is the liver. The brain involvement is unusual and up to 75% of cases are described in the pediatric population. We present six children with cerebral hydatid disease admitted to the Pediatric Hospital J.P. Garrahan. All had neurological involvement on admission. The images showed single cystic lesion in the brain. They did not present involvement in other organs. Serology was negative in all cases. Medical and surgical treatment in all cases. The clinical outcome was favorable without sequelae in five of them and one had a residual paresis right faciobrachiocrural. This infection should be considered in the differential diagnosis of cystic tumor lesions of the central nervous system.

La hidatidosis es una infección parasitaria causada por Echinococcus granulosus. El ser humano es un hospedero intermediario accidental. La localización más frecuente es la hepática. El compromiso cerebral es inusual, se describe que hasta 75% ocurre en población pediátrica. Se presenta una serie de seis niños con hidatidosis cerebral internados en el Hospital de Pediatría J. P. Garrahan. Todos presentaron compromiso neurológico al ingreso. Las imágenes mostraron lesiones quísticas únicas en el cerebro. No tuvieron compromiso de otros órganos. La serología fue negativa en todos los casos. El tratamiento fue médico-quirúrgico. La evolución clínica fue favorable sin secuelas en cinco de ellos y uno presentó una hemiparesia faciobraquiocrural derecha como secuela. Esta infección debe considerarse entre los diagnósticos diferenciales de lesiones tumorales quísticas del sistema nervioso central.

Primary intramedullary hydatid cyst: a case report and literature review.

Intramedullary hydatid cyst is extremely rare. We present a case of pathologically confirmed primary intramedullary hydatid cyst in an otherwise healthy patient. A 17-year-old boy presented with lumbar pain, weakness, and numbness in both lower limbs, and urinate difficulty interrupted for 2 years. The patient had no other signs of systemic hydatid cyst disease. An intramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after the surgical removal. Although extremely rare, primary intramedullary hydatid cyst pathology might be the cause of lumbar pain, weakness, and numbness in both lower limbs for those living in endemic areas. Surgical removement is feasible and effective for intramedullary hydatid cyst.

[Cerebral cystic echinococcosis in the light of our experience]. / Klinik deneyimlerimiz isiginda serebral kistik ekinokokkoz.

Cerebral cystic echinococcosis (CCE) is rare and constitutes 1-2% of all cystic echinococcosis. The cysts are usually solitary and most frequently located in the supratentorial region. CCE is classified as primary and secondary. The primary cysts developed from the embryos which escaped from the filter systems are more frequent and usually solitary and fertile. The secondary cysts result from spontaneous, traumatic or surgical rupture of the primary CCE by embolization of scolices. They are usually multiple and infertile and do not have brood capsule or scolices. Symptoms usually develop slowly and are usually due to increased intracranial pressure and depend on the location of the cyst. Diagnosis is made by evaluation of both clinical and laboratory findings. Computed tomography and magnetic resonance imaging is successful in the diagnosis. The cysts are observed as spherical, well defined, with thin regular margins by these methods. The most appropriate treatment method is total surgical removal of the cyst without rupture by using Dowling's method. However, when it is not possible to remove without rupture, the cyst should be removed totally after puncture and aspiration of contents of the cyst. After removal of large cysts, complications such as porencephalic cysts and subdural hemorrhage can occur postoperatively.

The complications of cerebral hydatid cyst surgery in children.

PURPOSE: Complications related to cerebral hydatid cyst surgery are not uncommon but require prompt diagnosis and treatment. The aim of this study is to demonstrate the radiological findings that would indicate complications after cerebral hydatid cyst surgery in children and to report our results. METHOD: The data of 25 pediatric patients who underwent surgery for cerebral hydatid cysts over a 16-year period were analyzed retrospectively. The complications related to surgical technique and cyst location were recorded. Postoperative radiological findings of the patients were documented. RESULTS: Intraoperative cyst rupture occured in three patients. Subdural effusion developed in five patients, porencephalic cyst in four, subdural effusion associated with porencephalic cyst in two, hemorrhage in two, epidural hematoma in one, and pneumocephalus in three patients. Subdural-peritoneal shunt was placed in two patients. Recurrence of cerebral hydatid cyst was observed in only one patient who experienced intraoperative cyst rupture. There was no surgery-related death. CONCLUSIONS: The complications following cerebral hydatid cyst surgery in children are various and usually not fatal. When appropriate surgical procedures are planned and carefully applied, the results will be excellent with no mortality.

Intracranial hydatid cyst in children: report of 30 cases.

PURPOSE: To analyze the clinical manifestations, radiological features, and surgical outcomes in 30 pediatric intracranial hydatid cysts. METHODS: We reviewed the clinical, radiological, and surgical aspects of pediatric intracranial hydatid cysts patients who received surgical treatment at the Neurosurgical department of Xinjiang Medical University between the years 1985 to 2007, retrospectively. RESULTS: Headache and vomiting were the most common initial symptoms in our series. Neurological deficits from the mass effect of the cysts were seen in 15 cases, including hemiparesis, visual deficit, and diplopia. Epilepsy occurred only in one patient with temporal lobe hydatid cyst. On computed tomography (CT), it presented as a round-shaped and thin-walled homogeneous low-density cystic lesion without surrounding edema and enhancement. Only five patients had a magnetic resonance imaging (MRI) scan, and presented low signal intensity on T1-weighted image and high signal intensity on T2-weighted image. Surgical removal of cyst was performed in all cases and intact removal was done in 29 cases. However, one cyst ruptured during the dissection of cyst wall, thus, resulting in one death. There were no additional neurological deficits which were caused directly by surgery. CONCLUSION: Increased intracranial pressure is common in patients with cerebral hydatid disease. CT and MRI are the first-line diagnostic procedures. Surgery is the treatment of choice for the majority of intracranial hydatid cysts. Multiple and deep seated lesions should receive medical treatment postoperatively.

Management of cystic echinococcosis complications and dissemination: where is the evidence?

This systematic review was designed to provide "evidence-based" answers to identify the best treatment for a complicated hydatid cyst of the liver and the appropriate management of disseminated cystic echinococcosis. An extensive electronic search of the relevant literature was performed using Medline and the Cochrane Library. This systematic review enabled us make to determine the best treatment options for the following conditions. Liver hydatid cysts ruptured into the biliary tract: Common bile duct exploration should be conducted using intraoperative cholangiography and choledoscopy. When the biliary tract is cleared of all cystic content, T-tube drainage should be sufficient. The principal difficulty concerned the management of the large biliocystic fistula: suture or internal transfistulary drainage or fistulization. Medical treatment is indicated in association with surgery for 3 months postoperatively. During the preoperative period, endoscopic retrograde cholangiopancreatography (ERCP) combined with preoperative endoscopic sphincterotomy (ES) may decrease the incidence of postoperative external fistula. Liver hydatid cysts involving the thorax: An abdominal approach is mandatory when common bile duct drainage is required, and it may be sufficient to treat a direct rupture into bronchi. An acute abdomen, owing to Liver hydatid cysts ruptured into peritoneum, requires an emergent operation. Medical treatment should be associated. Cystic echinococcosis of the lung: Surgery is still the main therapeutic option to remove the cyst, suture bronchial fistula if necessary, followed by capitonnage. Osseous cystic echinococcosis: Wide surgical excision is recommended. Cystic echinococcosis of the heart: Cystopericystectomy is the "gold standard" procedure but is sometimes unsuitable for particular sites. Cystic echinococcosis of the kidney: Cystectomy with pericystectomy is feasible in 75% of cases; nephrectomy must be reserved for destroyed kidney. Multiple associated cystic echinococcosis locations: Complicated cysts should be treated with high priority. In case of several cysts in the liver, spleen, and peritoneum, removal of all cysts in the same intervention is indicated when there is no threat to the life of the patient. Otherwise, a planned reoperation should be considered.

Surgical treatment of epilepsy with chronic cerebral granuloma caused by Schistosoma japonicum.

PURPOSE: To study the surgical treatment of epilepsy with cerebral granuloma caused by Schistosoma japonicum. METHODS: Two hundred fifty cases of epilepsy caused by cerebral schistosomiasis from 1955 to 2004 were analyzed retrospectively. RESULTS: There were no deaths. Follow-up of 196 cases for 4-5 years after operation demonstrated that 180 cases (92%) were seizure-free or well-controlled. CONCLUSIONS: Surgical treatment should be considered when drug therapy fails to control epilepsy or the lesion shows mass effect. Intraoperative electrocorticography monitoring is helpful to define the extent of the resection of the lesion.

Multiple cerebral hydatid cysts. Report of a case with 24 pieces.

A case of 19 years old female patient with 24 large primary cerebral hydatid cysts, in different localisations is presented. Cysts were removed unruptured by five separate operations in 6 months. The patient was observed to be in good health 1 year after the last operation. This case is the first case presented that contains such high number of cysts to our knowledge. The importance of MRI examination in localizing the cysts and designing the operative plan is emphasized. Interestingly, albendazole, which is an antiparasitic drug, was reported to be ineffective by infectious disease department of our hospital, because of large diameter of the cysts, in this case.

Contralateral migration of cerebral sparganosis through the splenium.

Even though it has been known for some time that the cerebral sparganosis could migrate to the contralateral hemisphere, there have been no reports which described the route of migration. This paper reports a case of cerebral sparganosis which migrated from the right temporo-occipital lobe to the contralateral temporo-occipital lobe though the splenium over a period of 3 years. A 24-year-old man visited our hospital complaining of headache for about a month. Three years ago, non-contrast MRI had been performed in a local hospital, and the major finding was cortical atrophy and ventricular dilatation in the right temporo-occipital lobe area, which were compatible with cerebral sparganosis. After admission to our hospital, we performed MRI which showed a 2 cm-sized well-enhanced mass in the left temporo-occipital area. The findings of the right side were similar to the MRI checked 3 years ago. The presence of multiple calcifications and small enhanced lesions on the right side also indicated that the old lesion had been a cerebral sparganosis. The most important finding was that the FLAIR image showed that the entire splenium had high signal intensity which linked the high signal areas of both hemispheres. The patient underwent surgery with the guidance of neuronavigation. The mass was well-capsulated, and removed totally in an en bloc fashion. After opening the capsule, we found a long worm which showed the shape of a whole lava but no movement. The histopathological diagnosis was sparganosis.

Surgical removal of a live worm by stereotactic targeting in cerebral sparganosis. Case report.

A 64-year-old man presented with generalized tonic clonic convulsion followed by weakness of the right lower extremity. He had a medical history of hypertension, hyperlipidemia, and right cerebellar infarction. Computed tomography (CT) showed a small high density nodule with an enhanced perifocal low density area in the left occipital lobe. T1-weighted magnetic resonance (MR) imaging showed a ring-shaped and partial string-like nodule with enhancement by gadolinium. T2-weighted MR imaging showed the white matter of the left occipital lobe as high intensity. CT and MR imaging seemed to indicate metastatic brain tumors, although cortical atrophy and ventricular dilation were recognized. Left parietal craniotomy was performed under stereotactic targeting to obtain a definitive diagnosis. During manipulation at the center of the targeted lesion, a white, tape-like body was found and recognized to be a live worm. Serological testing revealed strong immunopositivity against Spirometra mansoni. The infection route in the present case was probably through eating raw chicken meat. Cerebral sparganosis is extremely rare but should be considered in the differential diagnosis of metastatic brain tumors, especially in endemic areas.

Primary multiple intracerebral echinococcosis in a young child.

Primary multiple intracerebral echinococcosis is a very rare disorder particularly in children. In this case report we discuss the details of clinical presentation and management in a young child. We also highlight for the first time non-iatrogenic 'water lily' appearance of the lesion on computed tomography of the head.