Primary Intradural Extramedullary Hydatid Cyst

doi:10.1097/00000441-200504000-00006

The American Journal of the Medical Sciences

Volume 329, Issue 4, April 2005, Pages 202-204

https://doi.org/10.1097/00000441-200504000-00006 Get rights and content

ABSTRACT

Spinal hydatid cysts account for 1% of all cases of hydatid disease; primary intradural hydatid cysts are uncommon. We present a case of pathologically confirmed intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease. The patient presented with back pain, paraparesis, and weakness. An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after surgical removal. To our knowledge, this is the 25th case of hydatid cyst at an intradural extramedullary location reported in the literature.

Section snippets

Case Report

A 32-year-old woman presented with difficulty walking. She had a 6-month history of back pain and had recently developed bilateral leg weakness. Her physical examination findings were normal. Neurologic examination revealed bilateral lower extremity weakness and hypoesthesia in L4, L5, and S1 dermatomes bilaterally. Routine laboratory investigations and chest radiography findings were normal.

Magnetic resonance imaging revealed a 5X2X2 cm cystic lesion that was located intradurally at the L5-S2

Discussion

Egranulosus is a parasite, distributed mostly in sheep- and cattle-raising countries. Humans can be infected by ingesting the eggs. Oncospheres, which migrate to the portal circulation from the intestine, are trapped by liver and lungs. Spinal hydatid cysts account for 1% of all cases of hydatid disease.¹⁰ Spinal hydatid cyst can occur by direct extension from pulmonary or pelvic foci or, less commonly, begin primarily in the vertebral body.6., 8. Also, Echinococcus embryos can the reach the

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Cited by (41)

A Case of Extensive Thoracolumbar Spinal Intradural Cystic Echinococcosis
2022, World Neurosurgery
Citation Excerpt :
Patients with cysts confined to the intradural space typically present with compression of the spinal cord. The complete resection of the cysts without rupture is considered curative and feasible in most cases, even in the presence of adhesions to surrounding tissue.2,3 However, in the present case, only oral antiparasitic medication was given as the initial treatment, since the total removal of multiple cystic lesions was considered surgically to be impossible.
Spinal cystic echinococcosis (CE) is a rare but devastating form of a neglected parasitic disease caused by the larval stage of the cestode Echinococcus granulosus. CE or hydatid disease most commonly affects the liver and lungs. Spinal CE occurs in less than 1% of all cases. Patients with cysts confined to the intradural space typically present with neurological impairment due to compression of the spinal cord. We report a case of a 32-year-old woman with unusual, extensive spinal intradural CE, located at the T2–L5 levels. She was treated with surgical removal of the cystic lesions by laminectomy and instrumentation. Long-term oral albendazole was recommended postoperatively. Her status was medically stable at 5-year follow-up, but lower limbs paralysis, urinary retention, and bowel dysfunction persisted.
Spinal Hydatid Cyst Disease
2017, World Neurosurgery
Citation Excerpt :
In liver HC, despite the detection of high positivity rates by serologic methods, monitoring methods are more sensitive than serologic methods for diagnosing spinal HC diseases.43 MRI monitoring is the criterion standard for HC disease.3,5,37,43 Cysts are thin walled, have the same density as cerebrospinal fluid, and do not show septation.
A hydatic cyst (HC) is a zoonotic infection affecting the liver and lungs, with rare spinal involvement. We discuss the long-term results in 8 patients with spinal HC who were monitored at our clinic for 7 to 15 years.
The demographic data and clinicopathologic characteristics of 8 patients with spinal HC diagnosed between 2000 and 2016 were evaluated for their contribution to recurrence, and the long-term follow-up results were examined.
Four male and 4 female patients with a median age of 30.75 years (range, 17–45 years) at the first surgery were included. Infections were localized in the thoracic (3), thoracolumbar (1), lumbar (1), sacral (1), cervicothoracic (1), and lumbosacral (1) regions. Two patients had secondary HCs that spread from another organ (lung and kidney). Patients underwent 2 to 5 surgeries during the study period, with an average follow-up time of 8.5 years (range, 7–15 years) after the first surgery. The surgical treatments included an anterior corpectomy and anterior plate for a patient with cervical localization and cystectomy for a patient with sacral localization; the other patients underwent cystectomy with corpectomy and stabilization with an anterior approach, cyst excision and laminectomy with a posterior approach, or additional posterior transpedicular screw stabilization. The patients were prescribed albendazole.
Spinal HC treatment is difficult, particularly in patients with vertebral and paraspinal involvement, spinal instability, and recurrence. Long-term follow-up is critical, and patients require medical and surgical treatment, with regular clinical, radiologic, and serologic examinations. The cysts must be removed without rupture during surgery, and the surgical area must be irrigated with hypertonic saline solution to reduce the risk of recurrence.
Giant intradural extramedullary spinal hydatid cyst-a rare presentation
2012, Clinical Imaging
Citation Excerpt :
Spinal hydatid cysts are categorized into five groups: (a) intramedullary, (b) intradural extramedullary, (c) extradural (d) vertebral, and (e) paravertebral. Primary spinal intradural extramedullary type, as seen in our case, is an extremely rare form of hydatidosis [4]. Most common presentation of spinal hydatid includes paraparesis, sensory loss, bowel and bladder dysfunction, radicular pain, and cauda equine syndrome.
The hydatidosis, or echinococcosis, has a characteristic geographic distribution, occurring most frequently in sheep-raising regions in Mediterranean, Central Asian, and South American countries and in Australia. Spinal hydatidosis is very rare, and intradural location is a rarer category of spinal hydatidosis. We report a case of intradural extramedullary spinal hydatid cyst in a 9-year-old boy. On magnetic resonance imaging, an intradural extramedullary giant cystic lesion was seen mimicking an arachnoid cyst. However, endemic origin of the patient and positive serology helped to make the diagnosis of hydatid cyst, which was confirmed on postoperative histopathology.
Hydatid disease drug therapy primarily to reconstruction of a multilevel thoracolumbar vertebral lesion
2011, Revue de Chirurgie Orthopedique et Traumatologique
Nous rapportons un cas inédit d’hydatidose multi-étagée adjacente de la jonction thoracolombaire, isolée, avec compression médullaire. Deux mois après la mise en route d’un traitement antiparasitaire oral, le patient a bénéficié par voie postérieure d’une résection de la lésion, d’une décompression médullaire et d’une arthrodèse instrumentée T11–L3. Une arthrodèse par voie antérieure a été réalisée ultérieurement. Outre son intérêt diagnostique, ce cas amène à discuter différemment des lésions monoétagées par sa rareté, son indication d’artériographie médullaire préopératoire, son indication de chirurgie circonférentielle, le timing du traitement médicamenteux et l’attitude face aux lésions résiduelles.
Hydatid disease drug therapy primarily to reconstruction of a multilevel thoracolumbar vertebral lesion
2011, Orthopaedics and Traumatology: Surgery and Research
Citation Excerpt :
The preferential locations are the liver (60–70%) and lungs (10–15%). Bone involvement remains rare (0.5–2%), with vertebral locations observed in half of these cases, generally located in a single vertebra [1–4], although multivertebral involvement has been described [5–8]. These cases are marked by neurological complications, relapses, and considerable bone destruction.
We report, a very unusual case of multilevel vertebral hydatidosis adjacent to the thoracolumbar junction, without concomitant chord compression. Two months after initiating oral antiparasite treatment, the patient underwent resection of the lesion using a posterior approach, medullary decompression, and a T11–L3 instrumented arthrodesis. Arthrodesis via the anterior approach was performed at a later stage. In addition to its diagnostic value, this case raises renewed discussion about single-level lesions given their rarity: their indication for preoperative medullary angiography, their indication for circumferential surgery, the timing of medical treatment, and the strategy to implement for the residual lesions.
Primary Multilocular Extradural Spinal Hydatid Cyst
2021, Neurology India

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Case ReportsPrimary Intradural Extramedullary Hydatid Cyst

ABSTRACT

Section snippets

Case Report

Discussion

Surg Neurol

Clin Imaging

Neurochirurgie

Surg Neurol

MRI in primary intraspinal extradural hydatid disease: case report

Neuroradiology

Vertebral hydatid disease: radiological assessment

Radiology

Primary hydatid disease of the spine: an unusual cause of progressive paraplegia

J Neurosurg (Spine)

Dumbbell hydatid cyst of the spine

Spine

Available residual spinal hydatid cyst cured with albendazole

J Neurosurg (Spine)

Central nervous system hydatidosis in Turkey: a cooperative study and literature survey analysis of 458 cases

J Neurosurg

Case Reports
Primary Intradural Extramedullary Hydatid Cyst