Elsevier

World Neurosurgery

Volume 104, August 2017, Pages 1049.e7-1049.e10
World Neurosurgery

Case Report
Dumbbell-Shape Hydatid Cyst of Meckel Cave Extending to Cerebellopontine Angle and Middle Fossa; Surgical Technique and Outcome of Rare Case

https://doi.org/10.1016/j.wneu.2017.05.091Get rights and content

Background

Cerebral hydatid cyst is among the rare presentations of echinococcosis. Almost all the reported cases of intracranial hydatid cysts are in the cortical regions (parietal lobe in the territory of the middle cerebral artery), and all have been removed surgically using the water jet dissection technique. However, in locations in which there are several neuronal structures, such as the cerebellopontine angle, this method might not be applicable.

Case Description

A 62-year-old lady presented to our outpatient clinic with left-sided facial deviation, inability to close the eyes, and diplopia since a month before. She was diagnosed with having a dumbbell-shape lesion in the Meckel cave extending to the left cerebellopontine angle and middle fossa just lateral to the cavernous sinus. As it was adherent to the surrounding structures, we evacuated the contents using a fine needle and then dissected the cyst totally. The patient's symptoms alleviated after the surgery, and there was no residue. After the 2-year follow-up, our patient does not have recurrence.

Conclusions

The Meckel cave and cerebellopontine angle are rare locations for hydatid cysts, and the surgical technique is different due to adhesion of the cyst to several neuronal structures (lower cranial nerve, brainstem, and cerebellum). Needle aspiration along with dissection of the cyst microsurgically is recommended in similar cases.

Introduction

Echinococcosis with a hydatid cyst is an emerging zoonosis with an increasing incidence and prevalence worldwide.1 The main regions include Australia, New Zealand, China, India, South America, and the Middle East.2 The prevalence of the disease has been reported to be 1.44 per 100,000 individuals in Iran.3 Lung and liver are the main sites for the primary hydatidosis; however, any organ can be involved including the brain.4, 5, 6, 7, 8, 9 Several reports have described the clinical findings, surgical technique, and outcome of patients with cerebral hydatidosis undergoing surgical removal.10, 11 Almost all the reported cases of the intracranial hydatid cysts are in cortical regions (parietal lobe in the territory of the middle cerebral artery), and all have been removed surgically using water jet dissection technique.4, 5, 6, 7, 8, 10, 12 Rare cases have been reported in other locations, such as posterior fossa.13, 14, 15, 16, 17 This technique is applicable in almost all cerebral hydatid cysts, according to the fact that the cyst does not have adhesions to the surrounding pia matter.10 However, in locations in which there are several neuronal structures, such as the cerebellopontine (CP) angle, this method might not be applicable. We herein describe our experience with successful removal of a hydatid cyst from the CP angle in an adult patient.

Section snippets

Case Report

A 62-year-old lady presented to our outpatient clinic with left-sided facial deviation, inability to close the eyes, and diplopia since a month before. Diagnosed with diabetes mellitus (DM) and on oral medications for about 20 years, she was suspected to suffer from diabetic neuropathy involving the cranial nerves. Thus she was managed conservatively until the symptoms progressed despite tight blood sugar control. On physical examination she had paresthesia of the left side of the face (V1 and

Discussion

Hydatidosis is increasing in the world despite advances in prevention and detection of the disease in the animals.1 Although the disease mostly involves the lung and liver, all organs can be infected as the parasite is disseminated through the bloodstream.2 Surgery remains the treatment of choice in all patients with hydatid cyst.3 Several cases have described the clinical, radiologic, and surgical technique in patients with intracranial hydatidosis.6, 7, 8, 10, 11 The intracranial hydatid cyst

Acknowledgment

We thank the patient who provided us with the permission to publish her case and for her patience and follow-up. We also thank the personnel of the Chamran Hospital operating room. The editorial assistance of Diba Negar Research Institute is also appreciated for improving the style and English of the manuscript.

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    Citation Excerpt :

    Schwannoma, meningioma and epidermoid cyst comprise the majority of CP angle lesions. Unusual pathologies which may arise at CP angle include arachnoid cyst, choroid plexus papilloma, medulloblastoma, ependymoma, atypical teratoid-rhabdoid tumor, chordoma, chondrosarcoma, lymphoma, exophytic brain stem glioma, lipoma, posterior fossa aneurysm and hydatid cyst [12,13]. Öğrenci et al. [11] analogized it to pandora’s box which we are not determinate whether to open it or not.

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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