Surgical Management of Multiple Cerebral Hydatid Cysts without Systemic Involvement: A Case Report

Abstract

Hydatidosis is a rare and serious parasitic disease caused by Echinococcus granulosus larvae, with central nervous system (CNS) involvement being a potentially fatal complication. We present a case of neurohydatidosis in a 55-year-old male farmer exhibiting symptoms of the left parietal syndrome. Imaging studies revealed six well-defined, non-enhancing cystic lesions in the left parietal lobe, and serological evaluation confirmed the presence of Echinococcus-specific IgG antibodies. A chest-abdomen-pelvis CT scan showed no additional hydatid cysts in other organs.

The patient underwent microsurgical resection of all six cerebral parietal cysts without rupture, using Dowling's maneuver of hydrodissection with isotonic saline solution. Intraoperatively, the membrane of a previously ruptured seventh cyst was found and excised, and the remaining cavity was irrigated with hypertonic saline solution to prevent recurrence. The patient recovered well without any new neurological deficits or postoperative complications, and a histopathological examination confirmed the diagnosis. He was discharged with previous symptoms in remission and continued antihelminthic treatment with albendazole for 28 days.

Cerebral cystic echinococcosis should be included in the differential diagnosis for patients with multiple cystic lesions in the brain. This case report highlights the unusual presentation of multiple cerebral hydatid cysts without the involvement of other parenchymal organs. Surgical resection using hydrodissection combined with antihelminthic therapy is an effective treatment approach for neurohydatidosis.

Resumo

A hidatidose é uma doença parasitária rara e grave causada pelas larvas de Echinococcus granulosus, com envolvimento do sistema nervoso central (SNC) sendo uma complicação potencialmente fatal. Apresentamos um caso de neurohidatidose em um agricultor de 55 anos que manifestava sintomas da síndrome parietal esquerda. Estudos de imagem revelaram seis lesões císticas bem definidas e não captantes no lobo parietal esquerdo, e a avaliação sorológica confirmou a presença de anticorpos IgG específicos para Echinococcus. Uma tomografia computadorizada de tórax, abdômen e pelve não mostrou cistos hidatídicos adicionais em outros órgãos.

O paciente foi submetido à ressecção microcirúrgica de todos os seis cistos parietais cerebrais sem ruptura, utilizando a manobra de Dowling para hidrodissecção com solução salina isotônica. Durante a operação, a membrana de um sétimo cisto, previamente rompido, foi encontrada e removida, e a cavidade restante foi irrigada com solução salina hipertônica para prevenir recorrência. O paciente teve uma boa recuperação, sem nenhum novo déficit neurológico ou complicações pós-operatórias, e o exame histopatológico confirmou o diagnóstico. Ele teve alta com os sintomas anteriores em remissão e continuou o tratamento anti-helmíntico com albendazol por 28 dias.

A equinococose cística cerebral deve ser incluída no diagnóstico diferencial para pacientes que apresentam múltiplas lesões císticas no cérebro. Este caso destaca a apresentação incomum de múltiplos cistos hidáticos cerebrais sem envolvimento de outros órgãos parenquimatosos. A ressecção cirúrgica usando hidrodissecção combinada com antihelmínticos é uma abordagem eficaz para neurohidatidose.

Keywords

echinococcus granulosus - cerebral hydatid cysts - dowling's technique - antihelminthic therapy

Palavras-chave

echinococcus granulosus - cistos hidatídicos cerebrais - técnica de dowling - terapia anti-helmíntica

Publikationsverlauf

Eingereicht: 24. November 2023

Angenommen: 20. März 2025

Artikel online veröffentlicht:
07. Juli 2025

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