Management of problematic intracranial hydatid cysts

The authors report four patients with intracranial hydatic cysts. One patient had a pontine lesion which was punctured and aspirated and the cyst wall removed with a satisfactory outcome. The second patient had multiple cysts which was comparable to meningeomatosis. She had a rapidly deteriorating neurologic condition which proved to be fatal in spite of two consecutive surgical interventions. The third patient had nine lesions although only six were evident on the MRI. All of the cysts were removed, while two cysts ruptured. Multiple paracardial cysts of this patient were surgically removed shortly after the craniotomy. The last patient, again with multiple intracranial hydatid cysts had safe, total removal of all cysts. The first postoperative control CT raised the possibility of recurrence since the CT was highly suggestive of a hydatid cyst. However, this was not confirmed in the follow-up CT examination. Problems and the solutions of management are discussed.