Multiple infected extradural parasellar hydatid cysts

Intracranial hydatid disease constitutes 1%-2% of all cases of hydatid disease. Multiple, infected, extradural, parasellar hydatid cysts in a patient constitutes an extremely rare presentation.

This 21-year-old man presented with a progressive left supraclavicular swelling of 3 years duration and raised intracranial pressure of 6 months duration with a past history of left-sided chronic suppurative otitis media that had resolved with antibiotics. On neurologic examination, he had bilateral deterioration of vision with optic atrophy; right temporal field defect; left III, IV, VI, VI, and V2 cranial nerves palsy; and left ear conductive deafness. The patient's E.S.R was raised. His computed tomography (CT) scan showed a hypodense, lobulated lesion in the middle cranial fossa with a hypodense, nonenhancing rim, septations, and focal calcification without perifocal edema. A purulent fluid was aspirated from the left supraclavicular swelling, which did not reveal any organism on staining and culture. Aspiration of the left temporal swelling showed whitish watery fluid, the cytology of which revealed an infected hydatid cyst. Excision of the left temporal extradural, hydatid cysts was done, except the portion of the capsule adherent to the dura, and albendazole was started. One month later, the supraclavicular hydatid cysts were removed. Six months later, a left mastoidectomy was performed for chronic suppurative otitis media. A repeat CT scan showed complete resolution of the hydatid cysts. There was no recurrence at 1 year follow-up.

A rare case of multiple infected extradural hydatid cysts of the parasellar region is reported. The unusual CT picture of a hypodense lobulated mass with septations and a hyperdense rims is presented. The difficulties in its complete excision and successful management with long-term albendazole therapy are discussed.