Al Zain T J, Al-Witry S H, Khalili H M, Aboud S H, Al Zain F T
Department of Neurosurgery College of Medicine, Baghdad University, Iraq.
Acta Neurochir (Wien). 2002 Nov;144(11):1179-85. doi: 10.1007/s00701-002-0987-5.
Multiple intracranial hydatidosis (MIH) is a rare disease, with serious neurological manifestations, high recurrence and a mortality rate comparable sometimes to malignant disease. The causes of multiple infestations and their mechanisms are not clearly understood. Several attempts at classification are reported in the literature, but the diversity in location of these cysts in the brain and other organs, their appearance and recurrence rates remain largely unexplainable.
Multiple intracranial hydatidosis (MIH) is reported in a series of patients to evaluate their incidence, localization, complications treatment and recurrences. In this study we tried to explain the mechanism of multiple infestations, and to propose a new classification.
This was a retrospective study of thirty-four patients with MIH, treated between 1976 and 1999. The diagnosis was made mainly by CT scan and confirmed by surgery. MIH following iatrogenic rupture of a solitary cyst in the brain was excluded. Hydatid cysts were removed by the method described by Arana-Iñiguez (1973) using Dowling's technique. Histopathological examination was used to confirm the presence of scolices. The patients were followed-up for 3-14 years.
Twenty six patients (76.4%) were under the age of 20 years with a male to female ratio of 1.0:1.83. Clinically, patients with cysts exhibited features of increased intracranial pressure and focal neurological deficit. The cysts had a diameter between 2 to 120 millimeters. Histopathological examination showed that 63.6% of the cysts were fertile. Eleven patients (46.4%) achieved a good outcome. The operative mortality rate was 10.7%. Overall mortality was 17.6%. Five patients had more than one recurrence, which appeared after 3 months to 3 years.
MIH are rare; to date only 77 reported cases have been encountered. To have such a high incidence in Iraq raises the possibility of a different strain of Echinococcus granulosis. A suggestion is made regarding terminology and classification.
多发性颅内包虫病（MIH）是一种罕见疾病，具有严重的神经学表现，复发率高，死亡率有时与恶性疾病相当。多次感染的原因及其机制尚不清楚。文献报道了几种分类尝试，但这些囊肿在脑和其他器官中的位置多样性、外观及复发率在很大程度上仍无法解释。
报告一系列多发性颅内包虫病（MIH）患者，以评估其发病率、定位、并发症治疗及复发情况。在本研究中，我们试图解释多次感染的机制，并提出一种新的分类方法。
这是一项对1976年至1999年间接受治疗的34例多发性颅内包虫病患者的回顾性研究。诊断主要通过CT扫描做出，并经手术证实。排除脑内孤立囊肿医源性破裂后发生的多发性颅内包虫病。采用Arana-Iñiguez（1973年）描述的方法并使用Dowling技术切除包虫囊肿。组织病理学检查用于确认头节的存在。对患者进行了3至14年的随访。
26例患者（76.4%）年龄在20岁以下，男女比例为1.0:1.83。临床上，囊肿患者表现出颅内压升高和局灶性神经功能缺损的特征。囊肿直径在2至120毫米之间。组织病理学检查显示63.6%的囊肿有活性。11例患者（46.4%）预后良好。手术死亡率为10.7%。总死亡率为17.6%。5例患者有不止一次复发，复发发生在3个月至3年之后。
多发性颅内包虫病罕见；迄今为止仅遇到77例报告病例。在伊拉克有如此高的发病率增加了存在不同株细粒棘球绦虫的可能性。对术语和分类提出了一项建议。
