HYDATID INFESTATION OF THE BRAIN - DIFFICULTIES WITH COMPUTED-TOMOGRAPHY DIAGNOSIS AND SURGICAL-TREATMENT

The radiological, surgical and pharmacological management of 11 childr en with cerebral hydatid disease is presented with special emphasis on the varying CT and MRI appearances and the surgical difficulties we h ave encountered. All but 2 had enhanced CT scanning and 2 had an MRI. The typical CT appearance of a large non-enhancing cyst of CSF density with minimal oedema was only seen in 3 children. Atypical appearances included irregularity of the cyst wall contour (2), enhancement of th e surrounding rim (3), isodensity or heterogeneity of the cyst content (4), surrounding oedema (4) and globular as opposed to curvilinear ca lcification (2). Complete intact cyst removal was achieved in 3 patien ts. The reasons for puncturing the cysts or rupturing them at operatio n were failure to make a definitive pre-operative diagnosis (5), dense adhesions to the skull, dura or falx (3) and the misdiagnosis of an a rachnoid cyst and the subsequent placement of a cystoperitoneal shunt (I). Pathological examination suggests that the degree of the inflamma tory response to the ectocyst may determine the enhancement characteri stics and the ease of surgical removal. There was I recurrence which r esponded well to four 28-day treatment cycles of albendazole.