Unusual sites of hydatid disease: report of two cases of dumbbell formations.

Hydatidosis is a zoonosis caused by Echinococcus granulosus. Humans are accidentally contaminated by ingesting the parasite´s eggs mainly released through the faeces from infected dogs. Hydatidosis affects the bone in 0.5 to 2% of cases, with 44% of these cases involving in the spine. Vertebral hydatidosis is rare and it represents the most frequent and most dangerous form of bone involvement. This manifestation is extremely delicate, difficult to correctly identify and manage. The authors report two cases of vertebral hydatidosis revealed by medullar compression and increasing lumbar-radicular pain and functional impotence of lower limbs. Imaging showed multicystic bony lesions in lumbar spine. The extension into the spinal canal and to the perivertebral soft tissue were involved in both cases. We present those two cases to highlight the role of radiological exploration for diagnosis especially with magnetic resonance imaging (MRI) and the importance of monitoring this dangerous pathology.

Fatal alveolar echinococcosis of the lumbar spine.

For the last 10 years, the southern part of Belgium has been recognized as a low-risk area of endemicity for alveolar echinococcosis. This infection, caused by Echinococcus multilocularis, usually induces a severe liver condition and can sometimes spread to other organs. However, alveolar echinococcosis involving bones has been described only very rarely. Here, a fatal case of spondylodiscitis due to E. multilocularis contracted in southern Belgium is reported.

A rare case of intradural spinal hydatid cyst in a paediatric patient.

Intradural extramedullary type of spinal hydatid disease is a rare variety of hydatid disease, and is even rarer in paediatric age group. Spinal hydatid disease should be considered in the differential diagnosis of spinal cord compression syndrome in endemic countries and should be evaluated with imaging and serological investigations. Our case was a 9- year-old boy who presented with lower back pain lasting for 8 months and progressive bilateral lower extremities weakness lasting for 2 month. Neurological examination was suggestive of lower motor neuron type of paraperesis. Magnetic resonance images of the lumbar spine showed an intradural cystic lesion displacing and compressing the lower cord and cauda equina. The cystic mass was explored with L1-L4 laminectomy and after durotomy; it was separated from cord and dura mater by hydrodissection. It contained a clear fluid. The pathological diagnosis was hydatid disease.

Recurrent primary spinal subarachnoid neurocysticercosis.

STUDY DESIGN: Case description. OBJECTIVE: To describe a patient with a recurrent primary spinal subarachnoid neurocysticercosis (NCC) that was successfully treated with surgical decompression and medical therapy at our center. SUMMARY OF BACKGROUND DATA: Spinal subarachnoid NCC is thought to be the secondary result from larval migration through the ventricular system into the spinal subarachnoid space. However, this entity can develop as a primary infection through blood stream or direct larval migration. It can result in high recurrence and severe neurologic morbidity if it is not treated in an appropriate manner. METHODS: A 50-year-old woman with treatment history of spinal NCC presented with back pain and radicular pain. The lumbar magnetic resonance imaging showed a cystic lesion with septation and slight rim enhancement after gadolinium administration at the L4-S1 area. We performed surgical removal of this lesion and postoperative medical therapy for complete eradication of the parasite. RESULTS: The histopathology was diagnostic for a cysticercal cyst. Adjuvant medical therapy with albendazole was administered for 30 days after surgery. The patient remained symptom-free for 1 year after surgery without any evidence of recurrence. CONCLUSION: We report a rare case of recurrent primary spinal subarachnoid NCC at L4-S1 area. In cases of primary spinal subarachnoid NCC can be treated by adequate combined approach with surgery and medical therapy. Spinal subarachnoid NCC should be added to the differential diagnosis of primary spinal intradural cysts, because this lesion can occur primarily.

Extension of echinococcal spinal infestation extra- and intradurally after a decade of extinction.

Simultaneous intradural, extradural, vertebral and paravetebral invasion of hydatid cyst, pathologic fracture, and multiple vertebral involvement are all rare encountered conditions in echinococcal infestation. A 48-year-old man who had experienced a falling down trauma, 10 years ago, and at that time, because of L1 burst fracture, undergone on Harrington rod placement, admitted in our ward for newly started urinary retention and mild paresis of lower extremities. With imaging analysis and during surgery, we discovered the extension of echinococcal spinal infestation extra- and intradurally after a decade of extinction. We performed a double stage circumferential reconstruction and adjuvant long term chemotherapy. We closely monitor our patient neurologically and radiologically and believe that aggressive surgical treatment and sustained cyclical albendazole therapy can increase the quality of life and life expectancy.

Bone hydatid disease refractory to nitazoxanide treatment.

We report a patient with bone hydatid disease that was refractory to both long-term daily treatment with albendazole, combined with cimetidine or administered as monotherapy ( approximately 15 years) and a relatively short course of nitazoxanide combined with albendazole (3 months). Despite continuous daily medical treatment, bone invasion and destruction proceeded. His pain and disability progressively increased.

Spontaneous drainage of an asymptomatic recurrent hydatid cyst of the sacrum.

STUDY DESIGN: A case report. OBJECTIVE: This is an unusual presentation of recurrent hydatid disease. Spillage of a hydatid cyst was previously reported in a symptomatic case of primary spinal hydatid disease. However, we did not find any examples of spontaneous discharge of hydatid cyst fluid in an asymptomatic case in the literature. SUMMARY OF BACKGROUND DATA: Bone hydatid cysts occur in 1% to 2.5% of all patients with hydatid cyst disease, whereas 50% of bone hydatidosis cases are spinal. Diagnosis is difficult and patients usually present with neural compression symptoms. Surgery and antihelmintic medicine administration are considered as the treatments of choice. METHODS: In this report, a 35-year-old male patient, who underwent surgical and antihelmintic medical treatment 2 years previously, had a leaking cyst without neurologic symptoms. The patient underwent excision of multiple parasacral cysts from a posterior approach. Medical antihelmintic treatment was used after surgery. RESULTS: The postoperative period was uneventful. Follow-up MRI scans were performed at 6, 12, and 18 months after surgery. The few residual anterior perisacral cysts had, in fact, become smaller. CONCLUSION: The recurrence period of spinal hydatid disease may be silent without any neurologic deficits or pain; the only clinical manifestation may be leakage from a cyst. Curative therapies remain unlikely, but periodic follow-up MR images are advisable for early diagnosis of recurrence in order to obtain effective treatment.

Intradural extramedullary primary hydatid cyst of the spine in a child: a very rare presentation.

Spinal hydatid cyst is a serious but fortunately uncommon manifestation of the parasite Echinococcus, involving less than 1% patients with hydatid disease. Intradural hydatid cysts are extremely rare compared to other types of spinal hydatid cysts. We report a rare case of intradural, extramedullary spinal hydatid cyst in a 9-year-old male boy, who presented with weakness of both lower limbs for the last 4 months that was confirmed histopathologically; a better understanding of this rare but clinically challenging disease is intended by reporting this case.

Cauda equina syndrome caused by primary lumbosacral and pelvic hydatid cyst: a case report.

INTRODUCTION: Hydatid disease occurs in humans as a result of faeco-oral contamination and spinal echinococcosis is rare even in areas where echinococcosis is endemic. Hydatid cyst primarily occurs in the liver and lungs. Bone involvement constitutes only 0.5-2% of all hydatidoses. About half of the bone involvement occurs in vertebrae. The thoracic spine is the most common site of the spinal hydatidosis. Primary hydatid cysts of the lumbar and sacral spinal canal are very rare. CASE REPORT: We present a 31-year-old man with cauda equina syndrome caused by a primary hydatid cyst of the lumbosacral and pelvic areas. He had been admitted to hospital with left foot and low back pain three years ago. Magnetic resonance imaging revealed an intraspinal hydatid cyst extending from L2 to S2. The cyst had been totally removed. He was symptom-free for three years. After three years, he presented with acute cauda equina syndrome. His neurological examination revealed total plegia of dorsal flexion of the left foot and perianal hypoaesthesia. MRI showed lumbosacral and pelvic hydatidosis again. After total removal of the cyst, his neurological status revealed immediately relief. DISCUSSION: Hydatid cyst is an important health problem in some countries including Turkey. Bone involvement is seen in only 0.5-2% of cases. Furthermore sacral and lumber vertebral involvement is extremely rare. We presented a case with a spinal hydatid cyst which classified as a combination of intraspinal extradural, vertebral and paravertebral forms according to the Braitwate and Lees classification. Surgical excision and additional medical treatment is still the most effective treatment. Cysts located intraspinally have a tendency to rupture spontaneously. For this reason the high recurrence rate (30- 40%) is still a major problem in management.

A vertebral hydatid cyst infection mimicking tuberculous spondylodiscitis.

Hydatid disease involving the vertebral body and paravertebral soft tissues is rare even in rural areas where echinococcosis is endemic. The case of a 34-year-old woman with vertebral hydatid disease mimicking tuberculous spondylodiscitis (Pott's disease) is presented in this report. Spinal hydatid disease should be considered in the differential diagnosis of spondylodiscitis in endemic countries, and tested for with imaging and serology.

The effect of pedicle screw placement with or without application of compression across the neurocentral cartilage on the morphology of the spinal canal and pedicle in immature pigs.

STUDY DESIGN: Experimental study. OBJECTIVES: To investigate the effects of pedicle screw insertion on spinal canal and pedicle morphology in immature pigs, and, if transpedicular fixation has an effect, to document whether this occurs because of the inhabitance of the screw inside the growth plate (neurocentral cartilage [NCC]) or because of compression applied across the NCC. SUMMARY OF BACKGROUND DATA: Transpedicular fixation has been less commonly applied to the pediatric population, especially because of the risk of damage to the NCC. METHODS: Twelve newborn pigs (4-6 weeks of age) were operated on. Left sided pedicles from L1-L5 were studied, while right sides served as controls. Pigs were randomly assigned into 3 groups: (1) pedicles were probed only; (2) screws were inserted; and (3) after screw insertion, a washer and a nut were engaged at the pedicle entry point so that gradual compression across the NCC was achieved. After 4 months, spiral computerized tomography was used to measure the pedicle lengths and size of the halves of the spinal canal. RESULTS: In group 1, the operated hemi-canal area was not statistically different from the nonoperated side (P = 0.159). Pedicle screw insertion either with (P = 0.007) or without (P = 0.005) compression resulted in smaller hemi-canal area and shorter pedicles at the operated side, respectively (P = 0.008, P = 0.021). Approximately 4% to 9% shortening of the pedicle lengths and 20% to 26% narrowing of the hemi-canal areas on the instrumented side occurred with transpedicular instrumentation (groups 2, 3). CONCLUSION: Even without compression, pedicle screws passing through the NCC in immature pigs disturb spinal canal growth significantly. Clinical relevance for young children should be studied further.

A lasting solution is hard to achieve in primary hydatid disease of the spine: long-term results and an overview.

STUDY DESIGN: Retrospective evaluation of patients with primary hydatid disease was done, with an overview of the pertinent literature. OBJECTIVES.: To determine the results of surgical decompression and antihelminthic treatment. SUMMARY OF BACKGROUND DATA: Bone involvement in hydatid disease has been reported to be only 0.5 to 4%. Spinal involvement is found in 50% of these cases, with mortality over 50%. Paraplegia is the most serious complication of the disease, caused by compression of the spinal cord by the cysts. Aggressive surgery combined with antihelminthic therapy is recommended to eradicate the disease and prevent recurrence. METHODS: Three patients with primary spinal hydatid disease were operated on several times for multiple recurrences. Combined chemotherapy with either mebendazole or albendazole was also given. The mean age was 52 years, and the mean follow-up time was 92 months. RESULTS: Surgery and chemotherapy improved the symptoms in all cases but could not prevent recurrences and multiple operations. CONCLUSIONS: Primary spinal echinococcosis must be considered in the preoperative differential diagnosis of the atypical presentation of vertebral lesions, especially in patients with risk factors. Early diagnosis and preferably anterior radical surgery combined with antihelminthic therapy of sufficient duration are mandatory to at least halt the progression of symptoms, but these measures could not provide a lasting solution for the patients described here.

Primary spinal extradural hydatid cyst.

We report a rare case of spinal cord compression caused by primary multiple extradural hydatid cysts.

Primary spinal extradural hydatid cyst in a child: case report and review of the literature.

Spinal hydatid cyst is a rare but serious condition. An 8-year-old boy presented with back pain, progressive weakness and numbness in both legs. Magnetic resonance imaging (MRI) of the lumbar region showed a cystic lesion with regular contour located in extradural space. There was cerebrospinal fluid- (CSF-) like signal intensity on T1- and T2-weighted images. The lesion had excessively compressed the dural sac and caudal roots, and expanded to the L3 and L4 neural foramina. The case was explored with L2, L3, L4 laminectomy and the hydatid cyst was removed totally. The clinical presentation, diagnosis and surgical treatment of this rare case of spinal hydatid disease is discussed, and all available cases of primary extradural hydatid cyst reported in the literature are presented.