CLINICAL FEATURES AND OUTCOME ANALYSIS OF INTRACRANIAL HYDATID CYSTS
Abstract
Background: Hydatid cyst of the brain is a serious zoonotic parasitic infection which have profound health consequences if left untreated. The surgical excision of the cysts are rewarding for both the patient the neurosurgeon. Methods: The study was conducted prospectively at Department of Neurosurgery Hayatabad Medical Complex Peshawar from January 2013 to December 2014. Patients with a diagnosis of intracranial hydatid cysts were included, clinical and radiological features recorded, intervention and postoperative outcome were analysed. Results: Eleven patients with a male to female ratio of 1.7:1. Mean age was 12.4 (SD±6.5) years with median GCS on arrival of 10 (SD±2.5). Clinical features were headache (81.8%), vomiting (90.9%), seizures (36.4%), focal deficits (54.5%) and papilloedema (72.7%). The median GCS on discharge was 13 (SD±1.1) while GOS at 1 month follow up was 4 (SD±0.7). The bivariate analysis showed inverse correlation (R2=-0.68; p=0.02) between duration of symptoms and outcome while GCS on admission was positively correlated (rs=0.75; p=0.007) with the outcome. There was no mortality. Conclusion: Despite its rarity the clinical features are non-specific while radiological features help in establishing diagnosis. Earlier diagnosis and prompt intervention is the key to favourable outcome.References
Dandan IS, Soweid AM, Abiad F. Hydatid cysts clinical presentation. Emedicine. [Internet]. [cited 2015 Apr 2]. Available from: http://emedicine.medscape.com/article/178648-clinical
Tapia EO, Vidal TA, Antonio PL. Brain hydatidosis: report of four cases. Rev Med Chil 2012;140(3):358–63.
Taratuto AL, Venturiello SM. Trichinosis. Brain Pathol 1997;7(1):663–72.
Wani NA, Kousar TL, Gojwari T, Robbani I, Singh M, Ramzan A, et al. Computed tomography findings in cerebral hydatid disease. Turk Neurosurg 2011;21(3):347–51.
Osborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology 2006;239(3):650–64.
Umerani MS, Abbas A, Sharif S. Intra cranial hydatid cyst: A case report of total cyst extirpation and review of surgical technique. J Neurosci Rural Pract 2013;4(Suppl 1):S125–8.
Lakhdar F, Arkha Y, Bougrine M, Derraz S, El Ouahabi A, El Khamlichi A. Posterior fossa extradural and extracranial hydatid cyst. Neurochirurgie 2010;56(5):391–4.
Tsitouridis J, Dimitriadis AS, Kazana E. MR in cisternal hydatid cysts. AJNR Am J Neuroradiol 1997;18(8):1586–7.
Duransoy YK, Mete M, Barutcuoglu M, Unsal UU, Selcuki M. Intracranial hydatid cyst is a rare cause of midbrain herniation: A case report and literature review. J Pediatr Neurosci 2013;8(3):224–7.
Zhang W, Wen H, Li J, Lin R, McManus DP. Immunology and immunodiagnosis of cystic echinococcosis: An update. Clin Dev Immunol 2012;2012:101895.
Reddy DR. Managing cerebral and cranial hydatid disease. Neurol India 2009;57(2):116–8.
Krajewski R, Stelmasiak Z. Cerebral hydatid cysts in children. Childs Nerv Syst 1991;7(3):154–5.
Duishanbai S, Jiafu D, Guo H, Liu C, Liu B, Aishalong M, et al. Intracranial hydatid cyst in children: Report of 30 cases. Childs Nerv Syst 2010;26(6):821–7.
Ali M, Mahmood K, Khan P. Hydatid cysts of the brain. J Ayub Med Coll Abbottabad 2009;21(3):152–4.
Wang J, Cai B, You C. Surgical treatment options for cerebral alveolar echinococcosis: experience in six patients. Neurol India 2009;57(2):157–61.
Hariharan U, Garg R, Gupta A, Wasnik S, Pawar M. Anaesthetic concerns for large intracranial cyst excision: expect the unexpected! Clin Pract 2012;2(2):e50.
Nourbakhsh A, Vannemreddy P, Minagar A, Toledo EG, Palacios E, Nanda A. Hydatid disease of the central nervous system: a review of literature with an emphasis on Latin American countries. Neurol Res 2010;32(3):245–51.
Najjar MW, Rajab Y, El-Beheiri Y. Intracranial hydatid cyst. Dilemma in diagnosis and management. Neurosciences (Riyadh) 2007;12(3):249–52.
Todorov T, Vutova K, Petkov D, Balkanski G. Albendazole treatment of multiple cerebral hydatid cysts: case report. Trans R Soc Trop Med Hyg 1988;82(1):150–2.
Ciurea AV, Fountas KN, Coman TC, Machinis TG, Kapsalaki EZ, Fezoulidis NI, et al. Long-term surgical outcome in patients with intracranial hydatid cyst. Acta Neurochir (Wien) 2006;148(4):421–6.
Duishanbai S, Geng D, Liu C, Guo HR, Hao YJ, Liu B, et al. Treatment of intracranial hydatid cysts. Chin Med J (Engl) 2011;124(18):2954–8.
Behari S, Banerji D, Phadke RV, Shukla S, Krishnani N, Chhabra DK. Multiple infected extradural parasellar hydatid cysts. Surg Neurol 1997;48(1):53–7.
