PRIMARY HYDATID CYST OF SACRAL SPINAL-CANAL - CASE-REPORT

OBJECTIVE AND IMPORTANCE: Primary hydatid cysts of the spinal canal ar e very rare. The patient in the present case presented with lower caud a equina compression caused by a primary solitary hydatid cyst of the sacral spinal canal, which is a remote possibility. To the best of our knowledge, such a case has not been reported previously. CLINICAL PRE SENTATION: A 15-year-old male patient presented with lower motor neuro ne type of bladder and bowel involvement, with saddle-shaped anesthesi a involving S2-S5 dermatomes. Plain x-rays and magnetic resonance imag ing (MRI) scans revealed a widened sacral canal with pressure changes. MRI scans confirmed the cystic nature of the lesion, which had no spe cific characteristics and demonstrated intensities that were similar t o those of cerebrospinal fluid. TECHNIQUE: Surgical exploration of the sacral canal with enucleation of the cyst in tote was performed. A mi dline posterior approach was used by decompressing thinned posterior e lements. Adjuvant therapy with mebendazole or albendazole was not admi nistered, although recently, some authors claim good results with inte grated surgical and medical treatment. CONCLUSION: The patient experie nced dramatic improvement and became continent. At a follow-up examina tion after 1 year, he had only minimal urinary stress incontinence. If spinal hydatid cyst is surgically removed unruptured and other common primary sites are excluded, medical treatment can be deferred, provid ed the patient undergoes strict follow-up. MRI, although not specific for hydatid disease, should be the investigation of choice in suspecte d cases of spinal hydatid cyst.