cerebral hydatidosis: a reappraisal

the remarkable evolution of surgical management of cerebral hydatidosis towards an earlier diagnosis and proper treatment is evident from this 22-year retrospective study of our experience with 19 cases seen at shiraz university medical institutions. both cases of iatrogenically-induced infected cysts were seen during the pre-ct era. the optimistic view of being able to remove all the cysts intact seems to be elusive because six cysts ruptured during extraction even with application of the dowling technique. these cases were followed for a mean of 44 months and in only one case was the patient referred again with subarachnoid cysts of the lumbosacral region after two years. in six cases we had involvement of other organs also. there were two cases of multiple cysts in the brain, a case with de novo infection of the cyst contents, and one in which the cyst was epidural in the parieto-occipital region. one patient died pre-operatively and three were lost to follow-up however, fifteen patients were followed for a mean of27 months with eleven being neurologically intact and four with focal neurological deficits. one patient with a tapped cyst before extraction was readmitted two years later with paraplegia due to drop parasitic infestation of the thoracolumbar region.