[Horse tail syndrome revealing spinal-medullary hydatid disease]

Hydatid disease is an anthropozoonosis caused by the larval stages of the genus Echinoccus granulosus in humans. It mainly occurs in subjects living in the rural and livestock areas in the Mediterranean basin, South America, Near and Middle East. Spinal hydatid disease is rare but it is the most severe form of bone hydatid disease. It mostly affects the dorsal spine, increasing the risk of spinal injury; hence its severity. We here report the case of a 60-year-old female patient admitted with progressive bilateral, poorly systematized, paralyzing lumbar radiculopathy associated with urinary urgency. MRI showed lumbar spinal hydatid disease infiltrating the intra and extra-ductal structures and compressing the roots of the horse tail. The patient underwent surgery through a posterior approach with favorable outcome.

Endless story of a spinal column hydatid cyst disease: A case report

We describe a case of multifocal relapsing hydatid cyst following multilevel thoracic corpectomy and 360° instrumentation surgery. A 41-year-old male patient presented with cord compression and paraplegia due to a multiseptated cystic lesion at T10-11 level. The cyst was excised with a combined anterior and posterior approach and 360° stabilization was performed. The patient received albendazole for 1 year after the surgery. The patient presented with paraparesis 5 years after the surgery. Cystic lesions between C2-T1 and T10-11 were detected on the spinal MRI and the patient was operated with removal of the lesions on both levels and adjuvant local 20% hypertonic saline application. The patient received albendazole for the postoperative 6 months. After 3 months from the surgery, the patient's paraparesis recovered. There was no recurrence after 2 years from the last surgery.

A rare and unexpected clinical progress and location on a primary extradural spinal hydatid cyst in a pediatric patient: a case report

BACKGROUND

Involvement of spine in patients with hydatid disease (HD) is less than 1% and primary intra-spinal extradural HD is extremely rare. Although this disease is introduced as benign pathology according to its clinical presentation and biological behavior, intraoperative rupture of the cyst may aggravate the patients' outcome in the long-term especially in pediatric patient population.

CASE PRESENTATION

We report a 9-year-old girl who presented a progressive neurological deterioration due to an enlargement of a ventrally located extradural hydatid cyst within the thoracic spinal canal. Total removal of the cyst was achieved by preserving the capsule integrity for preventing potential seeding. Our preoperative initial diagnosis based on the radiological findings was confirmed as cyst hydatid histopathologically.

CONCLUSION

Cyst hydatid should be considered in the differential diagnosis of the presence of homogenous cystic lesions with regular shape inside the spinal canal especially in patients from endemic region. To our knowledge, this pediatric patient is the first case of cyst hydatid located ventral side of the spinal cord extradurally located inside the spinal canal showing no extension.

[Vertebral hydatidosis: case report]

Hydatidosis caused by echinococcus granulosus may affect any organ in the body, with the lungs and the liver as the most commonly affected organs. Vertebral compromise resulting from echinococcus granulosus has a low prevalence and accounts for less than 1% of bone compromise. We report the case of a 50 year-old female who presented at the Trauma Service with progressive low back pain with 5 months of duration that irradiated to the right lower limb, and led to neurologic compromise of the limb. Imaging studies showed spondylodiscitis at T12-L1, confirmed by a biopsy. Treatment of this condition is both orthopedic and surgical. The recurrence rate is high, between 30 and 40%. The objective of describing this case is to propose the differential diagnosis of a vertebral mass of unknown origin and provide details as to how to manage this condition.

Epidural and para spinal thoracic hydatidosis presenting with progressive paraparesis and paraplegia: a case report

We report a 16 year old male patient from rural Ethiopia with pathologically and intraoperatively proven thoracic para spinal and epidural hydatidosis, a very rare involvement, who presented with progresive both lower limb weakness, loss of pain, touch and properioception and double incontinence of two weeks prior to hospital admission. The pathological, radiological (MRI and plain x-ray) and the intra operative findings are briefly discussed with literature review.

[Radiological and surgical characteristics of a case of recurring spinal hydatidosis]

INTRODUCTION

Hydatidosis is an illness that is still to be found in our setting. The lungs and liver are the organs most frequently involved and it rarely extends to bones. Involvement of the spine is infrequent, but it can give rise to a high degree of disability and may recur despite apparently complete excision. Here we report a case of recurring spinal hydatidosis with radiological and surgical particularities.

CASE REPORT

Our case involves a 63-year-old male living in a rural area of the northern part of Spain's central plateau. The patient had a history of surgery for spinal hydatidosis and was on treatment with mebendazole. In the months before his visit, the patient had experienced difficulty in walking and urgency incontinence. The examination revealed paraparesis that predominantly affected the right-hand side and the patient required bilateral support to be able to walk. A dorso-lumbar magnetic resonance scan showed post-surgery changes with pedicular instrumentation added later in another centre, and a hydatid cyst with involvement of the body of the D10 vertebra, epidural extension and compression of the spinal cord. The patient was submitted to a surgical procedure involving the extraction of the system of fixation and full macroscopic excision of the cyst, with partial resection of the body of the vertebra. Initially the patient displayed motor improvement and treatment with mebendazole was reintroduced in high doses.

CONCLUSIONS

Spinal hydatidosis is a rare condition that, in spite of correct surgical and medical treatment, often recurs. Magnetic resonance scans show characteristic 'honeycomb' images, which are sometimes large and have their origins in the body of the vertebra. Although successive surgical interventions can become increasingly more difficult because of old instrumentation or the conservation of compromised vertebral bodies, aggressive excision is indicated while the patient still has useful neurological functioning.

Hydatid disease of the spine: a report on nine patients

PURPOSE

The author presents this prospective study of nine cases of pathologically confirmed spinal hydatid disease.

METHOD

Hydatid disease is a difficult diagnosis in non endemic areas but it should be considered in the differential diagnosis of spinal pathology in endemic areas. Spinal involvement is very unusual. There is nothing typical of spinal involvement. Nine patients presented with hydatid disease of the spine between September 2001 and October 2010. The patients were clinically evaluated as well as by the latest imaging modalities, haematological and serological tests. All had decompressive surgery with or without fixation and the diagnosis was confirmed by histopathological examination. All received albendazole and praziquantel for ten months.

RESULTS

MRI was the best diagnostic test, CAT scan was also useful, eosinophilia was a constant finding, and ESR was above normal in five patients. All had decompression laminectomy and clearance; in addition, transpedicular fixation was done to three patients. After surgery one patient had complete recovery with no recurrence, seven patients showed recurrence over time and residual disease was observed, and one patient died within 24 hours of surgery.

CONCLUSION

Diagnosis was easy from the start, but eradication was difficult, and recurrence rate was very high despite the use of chemotherapy.

Cystic hydatidosis: a rare case of spine localization

Cystic hydatidosis is a zoonosis endemic both to Sicily and other Mediterranean areas. Generally, Echinococcus granulosus tapeworms develop in the liver, lung and less frequently in the peritoneum, spleen or kidney. We present a rare case of spinal hydatid disease. The patient was a 38-year-old housewife with a vertebral echinococcosis revealed by acute paraplegia of the legs. Medical treatment with albendazole and surgical intervention improved the clinical symptoms. This case is emblematic both for the unusual localization and for the need of a multidisciplinary approach for diagnosing and monitoring suspected hydatid lesions. Patients with suspected abdominal or lung echinococcosis should also be investigated for other localizations such as the brain, spine and heart. Furthermore, in endemic areas hydatidosis must be suspected in the presence of lesions occupying space in these districts.

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.

Combined anterior and posterior approach for sacral/retroperitoneal hydatid cyst disease: case report

Achieving complete resolution of spinal hydatid cyst disease is quite challenging when bone is involved. Many authors reported the poor outcome of posterior decompression and laminectomy for intraosseous spinal hydatid disease. In an attempt to avoid a similar poor outcome, hydatid cysts were reached via both anterior and posterior surgical approaches in our patient. A 73-year-old man presented with complaints of low back and right leg pain. Symptoms or signs of systemic hydatid cyst disease were absent. MRI demonstrated a cystic lesion in the presacral/retroperitoneal region, involving the body of the sacrum and sacral canal. Computed tomography images showed enlargement of the sacral foraminae. The multiseptated cysts and their contents were isodense with cerebrospinal fluid. The cysts were removed via an anterior extraperitoneal approach, using a paramedian vertical incision, and then were also approached posteriorly via bilateral S1 hemilaminectomy. No neurological deficits occurred following surgery. The patient's symptoms completely disappeared after this combination of aggressive surgery and antihelminthic therapy. The application of both anterior and posterior approaches to intraosseous sacral hydatid cysts may be preferred when faced with hydatid disease in this location.

Primary spinal hydatid disease

Primary spinal hydatid disease is rare. Spinal hydatid disease should be considered in the differential diagnosis of spinal cord compression syndrome in endemic countries and evaluated with imaging and serology. Our case was a 34- year-old man. The patient presented with progressive back pain for 8 months and lower extremity weakness for 3 months. Neurological examination was suggestive of upper motor neuron type of paraperesis. Magnetic resonance images of the thoracal region showed an intradural multicystic lesion. The mass was explored with T 10-11 laminectomy. It had displaced the cord to the right side. The fluid was clear and did not contain pus. The lesion was easily dissected from the cord and was resected totally. The pathological diagnosis was hydatid disease.

[Anesthetic management of sacroiliac-vertebral echinococcosis]

Bone echinococcosis affects the spine and pelvis in 60% of cases. Bone lesions may be silent for between 10 and 20 years. The capsules progress aggressively through the medullary canal and replace the trabecular bone without forming cysts, as occurs in the organs, thus making anaplylaxis rare. The combination of chemotherapy and surgery facilitates anesthetic management and reduces the incidence of anaphylactic events and disease recurrence.

Primary sacral hydatid cyst. A case report

This case report highlights an unusual osseous spinal presentation of a well described disease, hydatidosis. A 59-year-old woman presented with increasing back pain and bilateral radiculopathy. Examination disclosed symptoms of spinal stenosis and urinary incontinence. Radiographs showed an expansive lytic lesion affecting the pelvic bones with destruction of the bone cortex. Laboratory analyses were performed and the patient underwent CT and MRI studies. Serology for Echinococcus was positive. When assessing sciatica, low back pain or lower limb weakness the pelvic cavity should be examined for hidden disease that might explain the neurological symptoms. Hydatid disease of bone should be considered in the differential diagnosis of any bone mass discovered in the human body. Diagnosis was delayed in this case because the pelvic cavity was not studied when radiculopathy symptoms started and there was no coexisting visceral involvement.

Long term follow-up of a patient with disseminated spinal hydatidosis

A rare case of a 27-year-old male patient with disseminated sacral hydatidosis is presented. Because the diagnosis was missed initially, the patient underwent only partial resection of the tumour to obtain tissue for histology. The resection was followed by deep wound infection, and re-exploration had to be performed, thereby resecting the remaining cyst tissue and the S1-S3 vertebral bodies. Adjuvant anti-helminthic therapy was started postoperatively. Unfortunately, the hydatid cyst further progressed and could only be controlled with multiple decompression procedures and continuance of anti-helminthic therapy. We review the diagnosis, treatment and prognosis of this uncommon condition, which is a serious challenge for the spinal surgeon.

[Primary hydatidosis of the chest wall. Report of 5 cases]

BACKGROUND

Hydatidosis is an endemic affection in Tunisia. Bone echinococcosis is a relatively rare entity accounting for only 0.5-2% of all hydatid cysts in humans and chest wall is an uncommon site for the disease.

AIM

Report of a new case

CASE

We report about this talk 5 cases concerning 2 men and 3 women (mean of age 35.4 years) explored for parietal mass (4 cases), or chest pain (1 case). Diagnosis was suspected on radiologic findings in all cases. All patients underwent surgery. Medical treatment was associated in 2 cases. Histopathology of resected specimen confirmed diagnosis of echinococcosis. No recurrence was observed during follow-up period.

Hydatid disease involving the left ventricle: A case of unusual combination

Hydatid cyst can be found in many organ systems, but is rarely in the heart. Echocardiography is an important tool in diagnosing cardiac involvement of a hydatid cyst. A history of extracardiac hydatid cyst should raise suspicion whether there is cardiac involvement. We report a case of spinal hydatid cyst with left ventricular hydatid cyst, yet without any hepatic or pulmonary involvement.

Primary hydatid disease of the spine: an unusual case

Hydatid disease or hydatidosis caused by Echinococcus granulosus is the most widespread, serious human cestode infection in the world. Bone involvement is reported in 0.5-4% with spinal involvement reported in 50% of these cases. We report a case of this rare entity of an isolated primary hydatid cyst of the spine in a 15-year-old boy, who presented with progressive back pain for 8 months, lower extremity weakness and urinary incontinence for 3 months. Neurological examination was suggestive of upper motor neuron type of paraperesis grade 1/5 with complete sensory loss below T4 level. MRI of the spine showed multiple cystic extradural lesions at the T4-5 level with involvement of the paraspinal muscles. The patient underwent a T4-5 laminectomy, and a total excision of the multiple epidural and paraspinal cysts. The diagnosis of hydatid disease was confirmed on histopathology. Albendazole was started postoperatively. At 6 months follow-up the boy had no neurological deficit, was playful, active and walking. Postoperative MRI at 6 months showed no recurrence of the lesion. Analysis of the other reported cases is discussed with relevance to our case.

[Costo-vertebral collection complicating multifocal echinococcosis: surgical drainage via an anterior approach]

INTRODUCTION

Costo-vertebral echinoccoccus is a rare and serious condition which often presents with neurological complications requiring urgent surgical intervention.

CASE REPORT

We report the case of a seven year old girl admitted with a clinical picture suggesting medullary compression secondary to multifocal Hydatid disease. As well as a costo-vertebral cyst with extension into the spinal canal, lesions were also seen in the lower lobe of her right lung and throughout the liver, confirmed by CT scan and by magnetic resonance imaging. A resection of Hydatid material as well as the posterior part of the 4th rib, the transverse process of the 4th costal vertebra and adjacent bone was carried out via a posterolateral thoracotomy. The cyst in the right lung was successfully excised at the same operation. Three months later six hepatic lesions were removed via a subcostal approach again without complication. A scan 23 months later revealed no evidence of residual hydatid disease.

CONCLUSION

This case illustrates the pathophysiological features of costovertebral Hydatid disease and the advantages of an anterior surgical approach.

Spinal hydatidosis

STUDY DESIGN

Retrospective study.

OBJECTIVES

To revise the treatment of spinal hydatidosis.

SUMMARY OF BACKGROUND DATA

About 50% of cases of bone hydatidosis are spinal.

METHODS

Twenty patients with spinal hydatidosis were treated. There were 13 men and 7 women, with a mean age of 53.1 years. The median follow-up was 4.8 years. The infected area was the cervical spine in 1 patient, the dorsal spine in 7, the lumbar spine in 7, and the sacrum in 5. Curettage and resection of the infected bone were performed. The spine was exposed posteriorly in all but 2 patients. An additional posterior decompression and fusion with instrumentation were performed after removing the involved posterior elements in 8 patients. An anterior approach was used in 2 patients: a total corpectomy was performed and a bone graft was added. Two weeks later, a posterior decompression and fixation with instrumentation was done. No preoperative drugs were used. Medical antihelmintic treatment was used after surgery in all but 8 patients.

RESULTS

Thirteen patients had spinal cord injury at the moment of surgery. The neurologic damage recovered only in 1 case. Repeated curettage was necessary in 13 cases: in 12 of them because of recurrence and in 1 because of surgical wound infection. In 6 cases of recurrence, there was also chronic wound infection. At last follow-up, 17 patients were free of disease.

CONCLUSIONS

The treatment of choice of spinal hydatidosis is surgical removal of the affected vertebrae combined with posterior stabilization, followed by postoperative adjuvant chemotherapy. Recurrence is very frequent.

Multiple recurrences of vertebral hydatidosis: a case report

We present a case of an Italian man with a particularly prolonged history of hydatid disease (more than 20 years, with six recurrences) involving both osseus (costal and vertebral) and visceral (pulmonary) sites. The main clinical problems involved in the diagnosis and management of vertebral manifestations of hydatidosis are discussed in the light of the latest clinical research.

[Vertebral hydatidosis: medical imaging and management. A case report]

Vertebral hydatidosis (VH) is uncommon. It is the most frequent skeletal manifestation of echinococcosis. It is also the most serious one. We report a case of VH revealed by a kyphoscoliosis with dorsal pain and point out the contibution of new medical imagings in the diagnosis of VH and in the patient follow-up. We stress on the difficulties of the care management of this disease and its poor prognosis because of the risk of neurological damages and frequent recurrences.

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.

Posterior decompression of spinal hydatidosis: long term results: Fundacion Jimenez Diaz, Madrid, Spain

Seven cases of spinal hydatid disease treated with posterior decompression were followed-up for an average of 20 years. The long-term results were very poor, with high rates of mortality, localised and extra-vertebral recurrence, significant neurological deficits, spino-cutaneous fistulae, spinal instability and pain.

Intramedullary schistosomiasis

A case study of intramedullary schistosomiasis in a 10-year-old child is reported. The patient presented with a short history of ascending paraparesis with no sensory loss. Sphincter dysfunction was rapid. She had surgical exploration and removal of a conus medullaris mass. Schistosomiasis was confirmed histologically. Combined steroid and praziquantel therapy improved her sphincter function and paraparesis.

[Filariae in vertebral canal, report of a case]

OBJECTIVE

To confirm diagnosis of a special case with chief complaints of abdominal pain and dyskinesia of lower extremities.

METHODS

The clinical symptoms, signs, MRI, pathological findings and the results of blood test for microfilaria were analyzed.

RESULTS

The patient was a 6-year old girl who had abdominal pain for 10 days dyskinesia of lower extremities for 6 days accompanied by difficulty in urination and defecation. There was tenderness on T7-9 spinous process, sensory dullness below the umbilicus. Babinski's and Oppenheim's sign were bilaterally positive, and ankle clonus was positive. MRI showed space occupying change in the vertebral canal at T7-9 level. The mass of 2 cm x 1 cm x 1 cm size was removed by surgical operation and histopathological study showed obvious fibrous tissue proliferation accompanied by eosinophil, lymphocyte and neutrophil infiltration around a worm-like structure. Night time blood test performed at 23:00 confirmed the presence of microfilaria.

CONCLUSION

The diagnosis of filariae in vertebral canal could be confirmed.

Multiple hydatid cysts of the neck, the nasopharynx and the skull base revealing cervical vertebral hydatid disease

Hydatid disease is caused by the parasitic tapeworm Echinococcus. This parasite in larval stage can thrive in many parts of the body, most commonly in the liver and the lung. Hydatid disease in the head and neck is uncommon and hydatid cyst presents rarely as a cervical mass. Cervical vertebral echinococcosis is rare. We report a 14-year-old girl with multiple cervical spine hydatid cysts of the C1-C2 vertebrae that spread into the surrounding paravertebral tissues and involve the nasopharynx and the skull base particularly the left jugular foramen. This process has caused a progressive swelling in the left side of the neck located in the retrostyloid compartment of the parapharyngeal space with paralysis of cranial nerves (VI, IX, X, XI, XII). The diagnosis was made based on the image obtained from CT and MRI examinations. Characteristics of this rare disease, diagnosis and treatment difficulty are discussed.

Hydatid disease of the spine in South African children

We present three patients with neurologic complications of the spine from hydatid disease. The first was a 6-year-old girl with lower limb paralysis evolving over 2 weeks. Neuroimaging revealed a cystic mass compressing the spinal cord at the level of T8 and extending from the vertebral body. She underwent surgical decompression. Histopathologic examination confirmed hydatid disease. At 6-month follow-up, functional improvement had occurred with full ambulation. She continues on long-term albendazole therapy. Two other patients are described, one with primary spinal disease and the other with cerebral disease and secondary seeding to the spine. Spinal hydatid disease is a rarity, even more so in children. Although secondary disease, primarily affecting bone, carries a poorer long-term outlook, the first patient made a dramatic recovery and has raised therapeutic dilemmas as to the total duration of continuing albendazole therapy. The literature documents some 37 reports, mostly in adults. Considering the frequency of hydatid disease in South Africa, the incidence in our population could be under-recorded. Unless the clinician includes spinal hydatid disease, in endemic areas, as part of the differential list for paralysis and considers performing neuroimaging, this potentially treatable diagnosis will be missed.

Multiple, primary spinal-paraspinal hydatid cysts

A patient is presented with widespread primary hydatid cysts in spinal-paraspinal locations, secondary to Echinococcus granulosus. An alternative mechanism to explain how the embryos gained access to the body is proposed: The embryos penetrated the intestinal muscle and may have directly entered into the inferior vena cava system through small venous connections between this system and portal circulation. Various conditions in daily life associated with Valsalva maneuver might have caused such an atypical passage of the embryos to the inferior caval system toward the retroperitoneum and spinal-paraspinal structures via lumber epidural venous plexuses.

[CT and MRI features of spinal hydatidosis. A report of 8 cases]

PURPOSE

Hydatidosis affects the bone in 0.5 to 2% of cases, with 44% of these cases involving the spine. We report 8 cases of vertebral involvement evaluated by CT and/or MRI. Materials and Methods. This retrospective study from January 1996 to August 2000 included seven patients (5 men and 3 women) aged between 28 and 65 years old. The mean age was 45 years old. Five patients underwent CT scan (one by CT-myelography). MRI was available in 4 cases.

RESULTS

Imaging showed multicystic bony lesions. Thoracic involvement was present in 4 cases, lumbar involvement in 2 cases, and sacral involvement in 2 cases. The process involved 2 adjacent vertebrae in 4 cases at the thoracic and lumbar levels and the entire sacrum in the other cases. Only one case of vertebral collapse was noted, but extension into the spinal canal was noted in all cases. Other sites of involvement were also noted, especially in adjacent soft tissues, liver and spleen.

CONCLUSION

The presence of multicystic vertebral lesions with involvement of adjacent soft tissues and/or distant organs should raise the possibility of spinal hydatidosis in endemic countries.

Hydatid disease of the spine. A long-term followup after surgical treatment

Vertebral hydatidosis is a relatively silent and slowly progressive disease with a latent period of many years. The prognosis for neurologic recovery in hydatid disease of the spine generally is regarded as poor and posterior surgical decompression is associated with a high recurrence rate. Reported here are the results after a long-term followup of four patients with hydatid disease of the spine with neurologic deficit which significantly improved after anterior surgical decompression and anthelmintic therapy. Adequate preoperative evaluation with magnetic resonance imaging and computed tomography scanning is essential in localizing the lesions and planning the surgical approach. The authors recommend radical excision of the involved vertebra and anthelmintic drugs to control the disease process.

A viable residual spinal hydatid cyst cured with albendazole. Case report

Spinal hydatid disease is a rare entity that frequently yields to severe, acute-onset neurological deficits. Although the gold standard treatment is total surgical removal of the cysts without inducing any spillage, it may not be possible to perform this in patients with multiple and fragile cysts. In such cases, the neural structures should be adequately decompressed and albendazole should be administered promptly. The authors describe the case of a 13-year-old girl who was admitted with a history of back pain and acute-onset lower-extremity weakness. Magnetic resonance imaging scans demonstrated severe spinal cord compression caused by multiple cysts involving T-4 and the mediastinum. The patient underwent surgery, and the cysts were removed, except for one cyst that was hardly exposed. Following histopathological confirmation of spinal hydatid disease, she was treated with albendazole for 1 year. One year postoperatively, the residual cyst had gradually shrunk and had almost disappeared. Although a single case is not sufficiently promising, we believe that administration of albendazole is efficient to prevent recurrences in cases in which it is not possible to obtain total removal of the cysts without inducing spillage.

Dumbbell hydatid cyst of the spine: case report and review of the literature

STUDY DESIGN

A case report of a hydatid cyst in the retropleural space at T7-T8 with an extension into the spinal canal through an intervertebral foramen complicated by paraparesis due to thoracic cord compression.

OBJECTIVE

To confirm that hydatid cyst should be considered in the differential diagnosis for any mass discovered in the human body.

SUMMARY OF BACKGROUND DATA

Appearance of a dumbbell-shaped mass in the thoracic spine is highly suggestive of neurofibroma. Hydatid cyst, although very rare, may have the same appearance. The spine is involved in 50% of hydatid disease of the bone. A hydatid cyst of the bone and muscle is always primary. Neurologic recovery is possible because it is a slow-growing lesion.

METHOD

Clinical symptoms, differential diagnosis, and treatment are reviewed. The patient was treated successfully by total surgical excision of the lesion through a posterior retropleural approach. No medical treatment was prescribed.

RESULTS

Surgical excision is effective in the treatment of hydatid disease of the spine, particularly if there is no extensive bony destruction and it is possible to achieve neurologic recovery after decompression of the thoracic spine.

CONCLUSION

Extra spinal hydatidosis may lead to spinal cord compression by extension through the intervertebral foramen. The possibility of cure is high when there is no bony involvement.

[Spinal intradural hydatid cyst. A case report]

The authors report the case of a 13-year-old girl in whom the diagnosis of intradural hydatid cyst was suspected on CT scan and MRI and confirmed at surgery. The interest of this case is related to the extremely rare location and its severe prognostic. CT scan and MRI can easily make an anatomic and topographic diagnosis of the intradural hydatid cyst.

Immunochemical and molecular characterization of vertebral hydatid fluid

This study describes a 42-year-old male born in Tunisia, who presented with vertebral hydatidosis which was initially misdiagnosed as Pott's disease. The correct diagnosis was finally made utilizing CT and MRI imaging and confirmation of the diagnosis was made possible by molecular and immunochemical characterization of the content of vertebral cyst fluid.

Vertebral unilocular hydatidosis in a shepherd and his wife

This paper reports vertebral unilocular hydatid cysts in a shepherd and his wife in Sharkia Governorate. Diagnosis was based on parasitological examination of the surgically removed cysts. Albendazole was given as postoperative treatment. MRI six months after treatment, showed no recurrence and mild clinical improvement.

[Isolated lumbar intradural hydatid cyst]

Intradural hydatidosis is a very uncommon form of vertebrospinal hydatidosis. We report a intradural lumbar localization, presenting the magnetic resonance imaging findings. We emphasize MRI for diagnosis and follow-up in search for residual or recurrent lesions.

[Isolated intramedullary cysticercosis. Case report]

BACKGROUND AND PURPOSE

Cysticercosis is the most common parasitic disease affecting the central nervous system. Although it is still very rare in Europe, the frequency will increase due to the influx of immigrants from the endemic areas and increasing trips in these countries. Spinal intramedullary cysticercosis is an uncommon manifestation of neurocysticercosis.

CLINICAL PRESENTATION

We report a case of pure intramedullary cysticercosis in a young white French girl, presenting as a progressive paraplegia with a cystic lesion in T4 on MRI. The diagnosis was made only after surgery by pathological examination.

CONCLUSIONS

A preoperative diagnosis of spinal intramedullary cysticercosis must be suspected not only in an endemic area in the presence of multiple soft tissue calcifications and segmental lesions revealed by myelography or MRI studies, but also for all cystic lesion of central nervous system even in no endemic area. Surgery is the unique treatment which can be used for spinal intramedullary cysticercosis and with the use of the microsurgical techniques for medullar surgery the outcome is not as dismal as reported earlier.