| Abstract: | Background:
Echinococcosis is still endemic in many countries, including China, especially in its north-west part, but the world literature which describes the Chinese experience in treating the cerebral hydatid cyst is still lacking. In this report, clinical manifestations, radiological features and surgical outcomes of 97 patients with intracranial hydatid cysts were analyzed and the transmission pattern, preoperative diagnosis, treatment methods and long-term outcome were discussed.
Methods:
We retrospectively reviewed the clinical features ( neurological symptoms and signs), radiological manifestations( X-ray, CT, MRI) and surgical outcome of 97 patients with intracranial hydatid cysts whom received surgical treatment at the neurosurgical department of Xinjiang Medical University between the year 1985 to 2010.We have followed up the patients via sending questionnaire or telephone contact. Clinical outcome was evaluated by using Karnofsky Performance Scale Index (KPSI).
Results:
Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases, which include hemiparesis, visual deficit, diplopia and aphasia. Epilepsy was occurred in five patients with hemispheric hydatid cysts. On X-Ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round shaped and thin walled homogeneous low-density cystic lesion without surrounding edema and enhancement were the main findings on CT in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts were manifested as a heterodensity lesions. On MRI, Hydatid cyst was manifested as a round low signal lesion in T1-Weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts were manifested as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulted in two surgery related mortality. There was no other additional neurological deficit caused directly by surgery. Patient outcome was 97.2% with Karnofsky Performance Scale score 80 to 90.
Conclusion:
Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas. CT and MRI have been proven to be the best diagnostic modality for diagnosing intracranial hydatid cyst. Surgery is the treatment of choice for intracranial hydatid cyst whenever possible. |
