Clinical Characteristics, Management, and Outcomes of Intracranial Hydatid Cysts in Pakistan: A Narrative Synthesis

A hydatid cyst is caused by Echinococcus granulosus. It is transmitted to humans via the feco-oral route. It occurs mostly in the liver or lungs. Intracranial occurrence is a very infrequent phenomenon. This review aimed to provide an insight into the clinicopathological spectrum of primary intracranial hydatid cyst and its management in Pakistani patients. Databases (PubMed and Google Scholar) and national journals were searched using predefined keywords from their inception until October 31, 2025. All case reports (CR), case series (CS), and original articles that satisfied the inclusion and exclusion criteria were included. A total of 11 studies were included, reporting data on 86 patients. The pooled mean age was 16.7 years, with a male predominance of 49 (59.03%). The median duration of illness was 12 (IQR: 6-12) months. The most frequently encountered symptoms were headache in 10/13 (76.90%), papilledema in 9/13 (69.20%), and motor deficit in 8/13 (61.50%). The most common location was supratentorial in 78/86 (90.70%), involving the fronto-parietal region in 21/83 (25.30%). Across the documented cases, the average diameter of the cyst was 8.81 cm. The lesion appeared hyperintense on T2 in six out of eight (75%) cases. Only 4/13 (30.79%) cases reported multiple cysts. Surgical management was opted for in all (86) cases. The Dowling technique was employed in 44 (51.16%), followed by excision in 41 (47.67%) cases. However, intraoperative cyst rupture was individually documented in three (23.07%) cases (from CR and CS). Postoperative meningitis was mentioned in only one CR. Medical therapy with albendazole was prescribed in nine (69.23%) cases, and it was continued for a mean of 28.80±28.89 weeks. The median duration of follow-up was 12 (IQR: 12-76) months. Recurrence was reported in three (23.07%) cases. Death was documented in 3/13 (23.07%) cases.  Meticulously performing the Dowling technique is safer to avoid intraoperative rupture. Subsequently, drastic complications can be prevented. Surgery, along with anti-helminthic administration, ensures the complete resolution of intracranial hydatid cysts. Long-term follow-up is necessary to investigate the course of the disease and achieve complete remission.