Intramedullary hydatid cyst of the cervical spine

Benign cervical intramedullary cyst without an epithelial lining：a case report

This paper presents a female, benign intramedullary cyst case aged 66-year-old. During the operation, it was found that the cystic wall was very thin, and the cystic fluid was colorless and transparent. The lesion with the capsule was removed partially. Surprisingly, there was no epithelial lining on the capsule wall. It is very rare and different from the benign intramedullary cysts reported in the literature.

Hydatid disease of central nervous system, a clinicopathological study of 33 cases

Objectives

Involvement of central nervous system (CNS) by Hydatid cyst is rare comprising 0.5-4% of all hydatid cysts and principally affecting those younger than 20 years, giving rise to cystic masses mostly in the cerebral hemispheres. To report the clinicopathological findings of CNS hydatid cysts, we diagnosed and review the findings of the previous studies.

Materials and Methods

All cases reported in our Section between January 1, 2001, and June 30, 2022, were included in the study. By searching our files, cases were retrieved, and diagnosis was confirmed. Follow-up was received on telephone. Ethical exemption was obtained.

Results

Thirty-three cases were diagnosed. Almost all were received from rural areas. There were 17 females and 16 males. Mean and median age were 20 and 19 years, respectively. Over 60% were younger than 20 years of age. All 33 involved the cerebral and cerebellar hemispheres. Seventy six percent were supratentorial while 24% were infratentorial. The most common signs and symptoms included weakness, headaches, and seizures. All appeared as solitary cystic masses on imaging. Almost 67% were clinically suspected to be hydatid cysts. Grossly, thin-walled transparent unilocular or multilocular cysts filled with viscous material were received intact in 52% and in multiple pieces in 48% cases. Intact cysts measured 7 cm on average. All demonstrated typical histology. Of the nine patients whose follow-up was available, one died from unspecified acute surgery related complications. Four patients were asymptomatic at the time of follow-up, whereas four developed recurrent cysts. All eight received albendazole therapy.

Conclusion

Cerebellum/posterior fossa location was common. Several cases were received in multiple pieces with increased risk of recurrence. Clinicopathological features were similar to those reported in literature. This series will hopefully serve to increase awareness regarding CNS hydatid disease.

Hydatid disease of the brain and spine

Hydatid disease of the central nervous system is relatively rare and comprises about 2-3% of all the hydatid cyst cases reported in the world. Spinal hydatid disease is an even rarer entity. It is endemic in sheep and cattle-raising regions, seen mainly in Mediterranean countries including Turkey and Syria. Pediatric neurosurgeons in non-endemic countries face a challenge when they encounter children with hydatid cysts of the central nervous system, mostly due to lack of awareness and the ensuing diagnostic dilemmas. It is also a significant socioeconomic problem in developing countries, due to improper hygiene and lack of dedicated veterinary practice. The clinical features are largely nonspecific and very according to location and severity of disease. However, with the advent of advances in MR imaging, the diagnostic accuracy of hydatic disease involving the brain and spine has increased. Intact removal of the cyst/s, without causing any spillage, and appropriate antihelminthic therapy is the goal and key to cure and prevention of recurrence. In this manuscript, the current literature on hydatid cyst of the brain and spine is reviewed to better understand the epidemiology, pathophysiology, diagnostic accuracy, and advances in therapeutic options. A heightened clinical suspicion, awareness of MR imaging features, improved surgical strategies, and options for prevention are discussed.

Isolated primary spinal epidural hydatid cyst in a child with progressive paraparesis

BACKGROUND

Primary spinal hydatid cyst is a rare but serious condition which occurs in about 1% of patients with hydatid disease. This disease may result in severe spinal cord compression presenting with various neurological deficits.

CASE REPORT

A 3-year-old boy was referred to our center with progressive weakness of lower limbs, frequency, and urinary incontinence. His parents did not report back pain during child's illness. Lumbar magnetic resonance imaging (MRI) revealed an extradural well-defined thin-walled cystic lesion at L4 to S3 vertebral levels without enhancement. The cyst had compressed the thecal sac associated with bone scalloping of vertebral bodies and posterior elements. Osteoplastic laminectomy of L4-L5 and laminectomy of S1-S3 was done. Intraoperative and histopathological findings indicated an epidural hydatid cyst.

CONCLUSION

Although spinal hydatid cysts are rare but might be considered in the differential diagnosis of any patient with signs and symptoms of spinal cord compression. The pathophysiology, clinical manifestations, epidemiology, diagnosis, and surgical treatment of extradural hydatid cyst are discussed.

Echinococcosis of the spine

Echinococcosis or hydatid disease affecting the spine is an uncommon manifestation of Echinococcus granulosus infection of the spine.More commonly found in endemic areas, it causes significant morbidity and mortality as it grows slowly and produces symptoms mainly by compressing the spinal cord.As diagnostic methods are non-specific, diagnosis and management are usually delayed until the disease is advanced, thereby therapy is usually unlikely.Treatment is usually surgical, aiming at cyst excision, spinal cord decompression and spinal stabilization.This article summarizes the clinical findings of echinococcosis of the spine, discusses the specific laboratory and diagnostic findings, lists the current treatment options, and reviews the patients' outcomes.The aim is to prompt clinicians to be aware of the possibility of echinococcosis as a possible diagnosis in endemic areas. Cite this article: EFORT Open Rev 2021;6:288-296. DOI: 10.1302/2058-5241.6.200130.

Skeletal manifestations of hydatid cystic disease in Sudan

Objectives

Hydatid bone disease is a zoonotic disease caused mainly by Echinococcus granulosus. Middle Eastern, African, and Mediterranean populations are endemically affected. Hydatid disease of the bone is a rare clinical condition that affects people with a history of animal contact. This research aims to revisit clinical presentations of hydatid cystic disease in the skeletal system.

Methods

Data of all clinical cases with hydatid cystic disease of the skeletal system, presenting between 2011 and 2016 were collected. Clinical manifestations and radiographic and histopathological reports were reviewed, and the patients were followed for a period of 12-22 months.

Results

Two patients had hydatid disease in the spine, one in the pelvis, one in the sternum, and one in the femur. The symptoms were suggestive of pathological fractures and bony deformities. Spinal hydatid disease presented with nerve root compression and paraparesis in one case, and radicular pain in the other case. Sternal involvement of hydatid disease presented with pain and deformity, while femoral involvement presented with deformity and fracture. Surgical resection with a pre- and post-surgical anthelminthic course and application of the puncture, aspiration, injection, and aspiration (PAIR) technique were completed in four cases. One case showed residual disease during follow-up visits.

Conclusions

Hydatid cystic disease of the skeletal system is a rare presentation of a common disease. A multidisciplinary approach is optimal for the management of these cases. Long-term follow-up is mandatory to prevent complications and recurrence, and to monitor residual disabilities.

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.

Case report of an epidural cervical Onchocerca lupi infection in a 13-year-old boy

A 13-year-old boy presented with fever and neck pain and stiffness, which was initially misdiagnosed as culture-negative meningitis. Magnetic resonance images of the brain and cervical spine demonstrated what appeared to be an intradural extramedullary mass at the C1-3 level, resulting in moderate cord compression, and a Chiari Type I malformation. The patient underwent a suboccipital craniectomy and a C1-3 laminectomy with intradural exploration for excisional biopsy and resection. The lesion containing the parasite was extradural, extending laterally through the C2-3 foramina. Inflammatory tissue secondary to Onchocerca lupi infection was identified, and treatment with steroids and doxycycline was initiated. At the 6-month follow-up, the patient remained asymptomatic, with MR images demonstrating a significant reduction in lesional size. However, 10 weeks postoperatively, the infection recurred, necessitating a second operation. The patient was treated with an additional course of doxycycline and is currently maintained on ivermectin therapy. This is the second reported case of cervical O. lupi infection in a human. In the authors' experience, oral doxycycline alone was insufficient in controlling the disease, and the addition of ivermectin therapy was necessary.