Carrea R, Dowling E, Guevara J A
Childs Brain. 1975;1(1):4-21. doi: 10.1159/000119553.
Single hydatid cysts of the brain are rarely seen by pediatric neurosurgeons who do not reside in certain countries, i.e. Australia, Uruguay, and Argentina. It is, however, of considerable importance that every pediatric neurosurgeon be aware of the manner of diagnosis of this condition and surgical management of these patients. Out of 35 cases of hydatidosis of the CNS and its covering observed over a 42-year period, there were 29 hydatid cysts of the brain and one of the spinal cord. Emphasis is placed on the former. Surgically, the hydatid cyst can be removed intact. The essential steps of the technique are: (1) a large flap; (2) careful handing during all the operative steps avoiding monopolar coagulation; (3) opening of the atrophic cortex overlying the cyst over an area whose diameter should be no less than three quarters of the diameter of the cyst, and (4) letting the cyst come out by just lowering the head of the operating table and instillating warm saline between the cyst and surrounding brain. In this series of hydatid cysts of the CNS, there was no operative mortality. The 20 cases in which the cyst was removed unbroken with Dowling's technique are alive and only two have sequelae of the preoperative lesion (blind). In the 11 cases in which Dowling's technique was not used and the cyst broke during ventriculography (3) or surgery (7, one broke spontaneously), only 7 are alive and well and there were 4 late deaths.
不住在某些国家（如澳大利亚、乌拉圭和阿根廷）的儿科神经外科医生很少见到脑内单发性包虫囊肿。然而，每个儿科神经外科医生都应了解这种疾病的诊断方法以及对这些患者的手术治疗，这一点非常重要。在42年期间观察到的35例中枢神经系统及其被膜包虫病病例中，有29例为脑内包虫囊肿，1例为脊髓包虫囊肿。这里重点讨论前者。在手术中，包虫囊肿可以完整切除。该技术的关键步骤包括：（1）做一个大骨瓣；（2）在所有手术步骤中小心操作，避免使用单极电凝；（3）在囊肿上方的萎缩皮质上切开一个直径不小于囊肿直径四分之三的区域；（4）仅通过降低手术台头部并在囊肿与周围脑组织之间注入温盐水，使囊肿自行脱出。在这组中枢神经系统包虫囊肿病例中，无手术死亡病例。采用道林技术完整切除囊肿的20例患者存活，只有2例有术前病变的后遗症（失明）。在未采用道林技术且在脑室造影（3例）或手术（7例，1例自发破裂）过程中囊肿破裂的11例患者中，只有7例存活且情况良好，有4例晚期死亡。
