Pediatric Intracerebral Hydatid Cyst; A Rare and Surgically Curable Entity: Case Report and Review of Literature
Ali Mehdi1, Syed Mohsin Raza Bukhari1, Hassan Mehdi1, Muhammad Salman Sajid1, Muhammad Moiz Javed2, Arif Hussain3, Syed Ijlal Ahmed4
1Nishtar Medical University and Hospital, Multan, 2Geisinger Wyoming Valley Medical Center, 3Department of Neurosurgery, PHQ HOSPITAL GILGIT, 4Department of Neurology, Saint Francis Medical Center
Objective:
To report a rare case of pediatric intracerebral hydatid cyst managed with Dowling’s Technique.
Background:
Cerebral hydatid disease is a rare manifestation of Echinococcus granulosus infection, accounting for less than 4% of all hydatid cases. It occurs predominantly in children from endemic, rural regions and poses diagnostic and therapeutic challenges due to its nonspecific presentation and potential for life-threatening complications.
Results:
We report the case of a 7-year-old girl who presented with complaints of progressive headache, vomiting, gait disturbances, and acute loss of consciousness. On physical examination the child was agitated, irritable, altered conciousness, with a Glasgow Coma Scale (GCS) of 9/15 (E2V2M5). Neuroimaging revealed a large, well-defined intracerebral cystic lesion consistent with a hydatid cyst. Systemic screening with chest X-ray and abdominal ultrasound did not reveal extracranial hydatid disease. The patient underwent emergency craniotomy with intact cyst excision using Dowling’s technique. Histopathology confirmed Echinococcus granulosus. Postoperatively, the patient showed rapid neurological improvement but required a second surgery for fluid reaccumulation. Sequential CT and MRI scans demonstrated progressive resolution of mass effect with satisfactory cerebral re-expansion. She was discharged on albendazole therapy for three months, with close clinical and radiological follow-up.
Conclusions:
This case underscores the importance of considering hydatid disease in pediatric patients presenting with space-occupying brain lesions in endemic areas. Early neuroimaging, meticulous surgical excision, and adjuvant antihelminthic therapy are crucial for favorable outcomes. Postoperative monitoring with serial imaging is essential to detect complications such as recurrence, residual cavity, or subdural collections.
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