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Cerebral hydatid cysts in children
1Department of Neurosurgery, Salaheldin University Hospital, Tripoli, Libya.
Insights
Surgery for intracranial Echinococcus granulosus cysts in children is effective, with standard craniotomy being the safest approach. Careful removal minimizes recurrence and complications like meningitis.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Infectious Diseases
Background:
- Intracranial cysts caused by Echinococcus granulosus are rare in pediatric neurosurgery.
- These cysts represent a significant portion of pediatric intracranial space-occupying lesions requiring surgical intervention.
Purpose of the Study:
- To analyze the surgical management and outcomes of pediatric patients with intracranial Echinococcus granulosus cysts.
- To evaluate the safety and efficacy of different surgical techniques, including standard craniotomy versus cyst puncture and drainage.
Main Methods:
- Retrospective review of 12 pediatric patients who underwent surgery for intracranial Echinococcus granulosus cysts over 5 years.
- Surgical procedures included standard craniotomy with cyst removal (intact or ruptured) and puncture/drainage before removal.
Main Results:
- Twelve children underwent 14 procedures; 13 utilized standard craniotomy.
- Complete cyst removal without rupture occurred in 6 cases; 5 involved puncture/drainage, and 3 had accidental rupture.
- One case of recurrence was noted, with another patient requiring reoperation twice for recurrent cysts.
Conclusions:
- Standard craniotomy appears to be the safest approach for intracranial Echinococcus granulosus cysts in children, minimizing contamination risks.
- While drainage aids removal, it increases contamination risk; intact cyst removal is preferred to prevent recurrence and complications such as non-bacterial meningitis.
Abstract:
Twelve children with intracranial cysts of Echinococcus granulosus underwent surgery during a period of 5 years and constituted 19% of all children operated on for intracranial space-occupying lesions. The more common symptoms were raised intracranial pressure (8 cases) and hemiparesis (7 cases). The total number of procedures was 14, with a standard craniotomy approach in 13. In 6 the cysts were removed without puncture or rupture, in 5 puncture and drainage were carried out before removal of capsule, and in 3 the cyst ruptured accidentally. Recurrence of multiple cysts occurred in 1 case and another patient was reoperated on twice for recurrent cysts after an operation in another center. There was no mortality. Non-bacterial meningitis occurred in 2 cases. Although drainage of the cyst contents greatly facilitates removal, it also carries a risk of contamination; thus a traditional approach via a large craniotomy seems to be the safest choice.