Intra cranial hydatid cyst: A case report of total cyst extirpation and review of surgical technique
A 22-year-old unmarried female presented to our outpatient department with one and half year history of headache of mild to moderate intensity, dull in nature, with no variation with time. She had no complaint of vomiting, tinnitus, hearing or vision loss. There was no history of head injury. Fundoscopy revealed normal fundi. There were no lateralizing or localizing signs. Laboratory data showed mild leucocytosis without significant eosinophilia. Her liver function tests were within normal limits. Plain chest X-ray and ultrasound scan of the abdomen and pelvis did not show any abnormality. CT scan of brain demonstrated a single large, spherical, well-defined, thin-walled homogenous, iso-dense cyst in the frontoparietal region, with non-enhancing wall [Figures and ]. This cyst was causing a midline shift of 1 cm, as well as dilatation of ventricles. MRI showed unilocular isointense cyst without surrounding edema []. Hence the diagnosis of a hydatid cyst was made. The patient underwent right frontotemporoparietal craniotomy. Following removal of bone flap and opening the dura, a small corticotomy of 1.5 cm was made in the frontal lobe through which the cyst was identified. A 10 French drainage tube was passed between the cortex and the cyst wall. Normal saline was carefully pushed in through this tube (Dowling's technique) to deliver the cyst measuring 5.5 × 5.8 cm2 []. A hydatid cyst was confirmed on histopathology. A CT scan after 48 hours of surgery showed a large cerebrospinal fluid (CSF) filled space without any residual cyst []. Post-operatively, Albendazole 10 mg/kg twice daily was started and continued for four months. The patient was discharged on third post-operative day with close follow-up. On subsequent follow up visits the patient had no headache or seizures.