Surgical treatment options for cerebral alveolar echinococcosis: experience in six patients.

BACKGROUND Cerebral alveolar echinococcosis (AE) is a rare but lethal parasitic disease. Its pathogenesis remains poorly understood. Currently there is no widely accepted methods for its surgical treatment. AIMS To discuss the surgical treatment options. SETTINGS AND DESIGN Hospital-based observational study. MATERIALS AND METHODS Patients who had surgery for cerebral AE during 2001 and 2007 were the subjects of the study. According to the lesion location and volume, patients have been allocated to either massive resection group or radical piecemeal resection group. Postoperatively, all patients received long-term aldendazole therapy in view of the associated hepatic involvement and were follow-up in the clinic. RESULTS Of the six patients with cerebral AE who were operated during the study period, four had massive resection and two had radical piece meal resection. None of the patients had postoperative neurological worsening and there was improvement in the neurological status in all the patients except for the patient with blindness. Of the 4 patients in massive resection group, two patients died during the follow-up, one because of liver failure and the other due to hydrocephalus. The remaining four patients were back to their normal activities and none had recurrence of the disease during the follow-up. CONCLUSIONS Although radical massive resection is generally regarded as the surgical method treatment for cerebral AE, radical piecemeal resection can be a reasonable, effective alternative management option, especially when massive resection might result in unavoidable morbidity and mortality.