Long-term follow-up and results of thirty pediatric intracranial hydatid cysts: Half a century of experience in the Department of Neurosurgery of theSchool of Medicine at the University of Istanbul (1952-2001)

A series of 30 documented cases of intracranial hydatid cyst out of 33 pedi atric and 45 total patients admitted to the Department of Neurosurgery of t he School of Medicine at Istanbul University within the years 1952-1996 is presented. The pediatric population consisted of 73% of the series. Twenty patients (66%) are alive and well after a follow-up period of 8-45 years (m ean 21.5 years). Six patients (20%) died and 4 (13%) were lost to follow-up . There were 3 early postoperative deaths (10%), 2 being in the pre-CT era. In 4 cases (13%), brain involvement was secondary, and 2 cases (7%) had mu ltiple intracranial hydatid cysts. Age ranged from 4 to 16 years, with a me an of 10.4. There were 5 intraventricular (17%) and 2 (7%) intracranial ext radural settlements. No children with posterior fossa hydatid cyst, primary skull hydatidosis or concomitant spinal involvement were detected. One pat ient (3%) presented with 'rhinorrhea' which in fact was a hydatid fluid lea k. Preoperative pseudocerebellar syndrome, convulsion and extrapyramidal si gns were seen in 6 patients each (20%). Five patients (17%) had permanent v isual deficits, 3 being in pre-CT era. Out of 29 patients operated on, hyda tid birth with intact cyst removal was achieved in 18 cases (62%), with no other manipulation needed. This rate has increased to 70% in the CT era. In traoperative accidental rupture occurred in 8 cases (28%), of which 7 were localized frontally or had a frontal involvement (88% of the ruptured cases ). Of the patients with intraoperative rupture, 5 are dead (63%) and they w ere all primary. In contrast, all 3 cases alive with intraoperative rupture are secondary. Three cases were punctured on purpose (10%). Four of the op erated patients (14%) required long-term antiepileptic therapy, 3 having no preoperative seizures. Only 1 patient required a shunt (3%). Four cases ha d recurrence, all with intraoperative cyst rupture (14%). The long-term eva luation of the results yielded an overall mortality rate of 21%. Routine us e of CT after the 80s decreased the rate to 14%. With the analysis of 50 ye ars of data, it is strongly concluded that brain involvement in pediatric h ydatid disease is a primary process if delayed diagnosis and insufficient t reatment of extraneural hydatidosis are prevented. Copyright (C) 2001 S. Ka rger AG, Basel.