Cerebral multiple echinococcosis: management with dowling technique – illustrative video article

Abstract

Hydatid Cyst (HC) is a zoonotic disease caused by Echinococcus granulosus, which is more common in povertystricken regions, such as in African countries and Southeast Asia, and rarely in Western countries. Canine is the definitive host, humans are the incidental hosts, and domestic animals such as cows and goats are the intermittent hosts. The lungs, liver, and brain are common sites of cyst formation in this condition. Depending upon the locations, the HC manifestation includes constitutional symptoms, abdominal pain, jaundice, and CNS symptoms.

Case Report: A 60-year-old male patient came to the Government Vellore Medical College Department of Neurosurgery with chief complaints of headache, vomiting, seizure, and subtle focal neurological deficit. The CT brain plain contrast shows a Multiloculated cystic lesion in the right parieto-occipital region with a minimal contrast-enhancing lesion. An MRI of the brain showed multiple cystic lesions involving the right parieto-occipital region and midbrain level. The patient was taken for surgical intervention, and numerous cysts were excised using the Dowling Technique. Patient was managed post-operatively with antiepileptic, steroids, and anti-helminthic management. Patient discharged on POD3.

Discussion: Human echinococcosis, also known as hydatidosis or hydatid disease, is caused by the larval stages of cestodes of the genus Echinococcus, most commonly Echinococcus granulosus. This disease is endemic in countries with large animal husbandry sectors, such as India and the Middle East. The most common site of hydatidosis is the liver (50%–60%) followed by the lung (20%–30%). Cerebral hydatid disease is an extremely rare manifestation, documented as 2% of space-occupying lesions. Computer tomography, MRI, and immunological tests are modalities used to diagnose cerebral hydatid cyst disease. It is more common in the supratentorial region, most commonly the parietal and occipital lobes. Surgical excision is the treatment of choice for cerebral hydatid cystic disease, but needs to be tailored to each patient. During surgical excision, the cyst was removed using the Dowling technique, which avoids cyst rupture and spillage of cystic fluid into the brain parenchyma. The medical line of management is anti-helminthic medication, such as albendazole, for 28 days.