MULTIPLE INFECTED EXTRADURAL PARASELLAR HYDATID CYSTS

BACKGROUND Intracranial hydatid disease constitutes 1%-2% of all cases of hydatid disease. Multiple, infected, extradural, parasellar hydati d cysts in a patient constitutes an extremely rave presentation. CASE REPORT This 21-year-old man presented with a progressive left supracla vicular swelling of 3 years duration and raised intracranial pressure of 6 months duration with a past history of left-sided chronic suppura tive otitis media that had resolved with antibiotics. On neurologic ex amination, he had bilateral deferioration of vision with optic atrophy ; right temporal field defect; left III, IV, VI, V1, and V2 cranial ne rves palsy and left ear conductive deafness. The patient's E.S.R was r aised. His computed tomography (CT) scan showed a hypodense, lobulated lesion in the middle cranial fossa with a hypodense, nonenhancing rim , septations, and focal calcification without perifocal edema. A purul ent fluid was aspirated from the left supraclavicular swelling, which did not reveal any organism sw on staining and culture. Aspiration of the left temporal swelling showed whitish watery fluid, the cytology o f which revealed an infected hydatid cyst. Excision of the left tempor al extradural, hydatid cysts was done, except the portion of the capsu le adherent to the dura, and albendazole was started. One month later, the supraclavicular hydatid cysts were removed. Six months later, a l eft mastoidectomy was performed for chronic suppurative otitis media. A repeat CT scan showed complete resolution of the hydatid cysts. Ther e was no recurrence at 1 year follow-up. CONCLUSIONS A rare case of mu ltiple infected extradural hydatid cysts of the parasellar region is r eported. The unusual CT picture of a hypodense lobulated mass with sep tations and a hyperdense rim is presented. The difficulties in its com plete excision and successful management with long-term albendazole th erapy are discussed. (C) 1997 by Elsevier Science Inc.