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Cerebral hydatidosis in childhood: a retrospective survey with emphasis on long-term follow-up
P Lunardi1, P Missori, N Di Lorenzo
1Department of Neurological Sciences, University La Sapienza, Rome, Italy.
Insights
Surgery for pediatric cerebral hydatid cysts shows excellent long-term outcomes. This study highlights the primary nature of brain echinococcosis in children, suggesting specific risk factors.
Area of Science:
- Neurosurgery
- Pediatric Infectious Diseases
- Parasitology
Background:
- Cerebral hydatid cyst (echinococcosis) is a rare but serious condition in children.
- Understanding the origin and long-term prognosis of brain hydatidosis is crucial for effective management.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical treatment for cerebral hydatid cysts in pediatric patients.
- To investigate the characteristics and potential etiological factors of primary cerebral echinococcosis in children.
Main Methods:
- Retrospective analysis of 12 pediatric patients who underwent surgery for cerebral hydatid cysts.
- Detailed review of surgical techniques, cyst characteristics, complications, and long-term patient follow-up (mean 28 years).
Main Results:
- Eight out of 12 patients demonstrated excellent long-term general and neurological health post-surgery.
- Complications included infection, intracranial recurrence, and systemic echinococcosis, with three deaths.
- Most cases were primary cerebral hydatid disease, with only one known secondary case.
Conclusions:
- Surgical intervention for pediatric cerebral hydatid cysts can yield favorable long-term results.
- Cerebral echinococcosis in children is often primary, potentially linked to patent ductus arteriosus and consumption of unboiled milk.
- Long-term surveillance is essential to monitor for recurrence and systemic disease.
Abstract:
We report the long-term outcome of surgery for cerebral hydatid cyst in 12 children. In only one child, who had been operated on for cardiac hydatidosis a year earlier, was the brain cyst known to be secondary. Of the 12 children, 10 had a single cyst and 2 had multiple cysts. Five single cysts were removed intact by "hydatid birth," two cysts--one single and one multiple--were removed after puncture and aspiration of the cyst fluid, and the other five--four single and one multiple--were accidentally ruptured in the course of the operation. One patient died of infection of the residual space, 2 died of intracranial recurrence of the parasite (7 and 22 months later, respectively), and one, the child with secondary cerebral echinococcosis, died 6 years later of systemic echinococcosis. Eight patients who had a mean follow-up of 28 years are still living and enjoy very good health, both general and neurological. This long-term follow-up with such good results confirms the usually primary character of cerebral hydatid disease, at least in children. The combination of patent ductus arteriosus and ingestion of unboiled animals' milk might well explain how primary cerebral hydatid disease develops in children.