Behari S, Banerji D, Phadke R V, Shukla S, Krishnani N, Chhabra D K
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Surg Neurol. 1997 Jul;48(1):53-7. doi: 10.1016/s0090-3019(97)85702-3.
Intracranial hydatid disease constitutes 1%-2% of all cases of hydatid disease. Multiple, infected, extradural, parasellar hydatid cysts in a patient constitutes an extremely rare presentation.
This 21-year-old man presented with a progressive left supraclavicular swelling of 3 years duration and raised intracranial pressure of 6 months duration with a past history of left-sided chronic suppurative otitis media that had resolved with antibiotics. On neurologic examination, he had bilateral deterioration of vision with optic atrophy; right temporal field defect; left III, IV, VI, VI, and V2 cranial nerves palsy; and left ear conductive deafness. The patient's E.S.R was raised. 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 purulent fluid was aspirated from the left supraclavicular swelling, which did not reveal any organism on staining and culture. Aspiration of the left temporal swelling showed whitish watery fluid, the cytology of which revealed an infected hydatid cyst. Excision of the left temporal extradural, hydatid cysts was done, except the portion of the capsule adherent to the dura, and albendazole was started. One month later, the supraclavicular hydatid cysts were removed. Six months later, a left mastoidectomy was performed for chronic suppurative otitis media. A repeat CT scan showed complete resolution of the hydatid cysts. There was no recurrence at 1 year follow-up.
A rare case of multiple infected extradural hydatid cysts of the parasellar region is reported. The unusual CT picture of a hypodense lobulated mass with septations and a hyperdense rims is presented. The difficulties in its complete excision and successful management with long-term albendazole therapy are discussed.
颅内包虫病占所有包虫病病例的1%-2%。患者出现多发、感染性、硬膜外、鞍旁包虫囊肿的情况极为罕见。
该21岁男性，左锁骨上渐进性肿胀3年，颅内压升高6个月，既往有左侧慢性化脓性中耳炎病史，经抗生素治疗已痊愈。神经系统检查发现，他双眼视力下降伴视神经萎缩；右侧颞侧视野缺损；左侧动眼神经、滑车神经、展神经、三叉神经眼支及上颌支麻痹；左耳传导性耳聋。患者血沉升高。计算机断层扫描（CT）显示中颅窝有一个低密度、分叶状病变，有低密度、无强化的边缘、分隔及局灶性钙化，周围无水肿。从左锁骨上肿胀处抽出脓性液体，染色及培养未发现任何病原体。左颞部肿胀处抽出白色水样液体，细胞学检查显示为感染性包虫囊肿。除与硬脑膜粘连的包膜部分外，切除了左侧颞部硬膜外的包虫囊肿，并开始使用阿苯达唑。1个月后，切除了锁骨上的包虫囊肿。6个月后，因慢性化脓性中耳炎进行了左侧乳突切除术。重复CT扫描显示包虫囊肿完全消退。随访1年无复发。
报告了1例罕见的鞍旁区域多发感染性硬膜外包虫囊肿病例。呈现了低密度分叶状肿块伴分隔及高密度边缘的不寻常CT表现。讨论了其完整切除的困难以及长期阿苯达唑治疗成功管理的情况。
