Subdural hydatid cyst presenting as recurrent subdural hygroma.

Area of Science:

• Neurology
• Parasitology
• Neurosurgery

Background:

• Intracranial hydatid disease, caused by Echinococcus granulosus, is rare and typically affects brain parenchyma.
• Subdural hydatid cysts are exceptionally uncommon, with no prior reports in existing literature.

Observation:

• A 13-year-old female presented with intracranial hydatid disease requiring surgical excision.
• Postoperatively, she developed recurrent subdural hygromas necessitating multiple interventions.
• The underlying cause of recurrent hygroma was identified as a subdural hydatid cyst.

Findings:

• The patient underwent initial craniotomy for cyst removal, followed by repeated burr hole drainage for hygroma.
• Subsequent management included subduro-peritoneal (SDP) shunt placement and later, ventriculoperitoneal (VP) shunt with SDP revision.
• During SDP shunt revision, a hydatid cyst was observed emerging from the burr hole site, leading to repeat craniotomy for complete removal.

Implications:

• Complete surgical excision is the definitive treatment for intracranial hydatid cysts.
• Preventing intraoperative spillage of cyst contents is paramount to avoid recurrence.
• Postoperative antihelminthic therapy is essential for all patients with brain hydatid disease.