Spinal Hydatid Cyst Disease : Challenging Surgery - an Institutional Experience

Abstract

Objective: Hydatid cyst disease is caused by the parasite Echinococcus granulosus. It is rarely seen in the vertebral system, occurring at a rate of 0.2-1%. The aim of this study is to present 12 spinal hydatid cyst cases, and propose a new type of drainage of the cyst.

Methods: Twelve cases of spinal hydatid cysts, surgical operations, multiple operations, chronic recurrences, and spinal hydatic cyst excision methods are discussed in the context of the literature. Patients are operated between 2005 and 2016. All the patients are kept under routine follow up. Patient demographic data and clinicopathologic characteristics are examined.

Results: Six male and six female patients with a median age of 38.6 at the time of surgery were included in the study. Spinal cyst hydatid infection sites were one odontoid, one cervical, five thoracic, two lumbar, and three sacral. In all cases, surgery was performed, with the aim of total excision of the cyst, decompression of the spinal cord, and if necessary, stabilization of the spinal column. Mean follow up was 61.3 months (10-156). All the patients were prescribed Albendazole. Three patients had secondary hydatid cyst infection (one lung and two hepatic).

Conclusion: The two-way drainage catheter placed inside a cyst provides post-operative chlorhexidine washing inside the cavity. Although a spinal hydatid cyst is a benign pathology and seen rarely, it is extremely difficult to achieve a real cure for patients with this disease. Treatment modalities should be aggressive and include total excision of cyst without rupture, decompression of spinal cord, flushing of the area with scolicidal drugs, and ensuring spinal stabilization. After the operation the patients should be kept under routine follow up. Radiological and clinical examinations are useful in spotting a recurrence.

Keywords: Management; Spinal cystic echinococcosis; Surgery.

Fig. 1.

Patient 11. A : Sagittal T2A weighted MRI showing sacral hydatid cyst infection. B : Sagittal T2A weighted MRI showing sacral hydatid cyst infection and paravertebral involvement. C : Contast enhanced sagittal T1A weighted MR. D : contast enhanced axial T1A weighted MR. MRI : magnetic resonance imaging, MR : magnetic resonance.

Fig. 2.

Patient 7, thoracic hydatid cyst. Decompression and instrumentation surgery is performed. Recurrent disease can be seen in paravertebral area and subcutaneous tissue. A : T1A weighted sagittal MRI. B : Contrast enhanced T1A weighted sagittal MRI. C : Contrast enhanced T1A weighted sagittal MRI. D : T2A weighted axial MRI. R : right, L : left, MRI : magnetic resonance imaging.

Fig. 3.

Patient 1. Sagital (A) and axial computed tomography scan (B) of a sacral hydatid cyst patient, after 3rd operation.

Fig. 4.

Patient 4, X-Ray scan of a thoracic hydatid cyst patient. Spinal stabilization and laminectomy were performed. Antero-posterior (A) and lateral X-ray scan (B).

Fig. 5.

Continuous drainage of the hydatid cyst.