Unveiling a Giant Hydatid Cyst of the Brain: A Neurosurgical Experience with a Rare Zoonotic Infection

Abstract

Cerebral hydatid disease is a rare but important manifestation of Echinococcus granulosus, comprising 0.5%–2% of all hydatid cases. It primarily affects children in endemic regions and often remains asymptomatic until the cyst reaches a considerable size, making early diagnosis challenging. An 11-year-old boy from rural Punjab, Pakistan, presented with progressive headache and head enlargement for four months, without seizures or neurological deficits. MRI revealed a large, well-defined cyst (10.9 × 10.2 × 11.2 cm) in the left parieto-occipital region, producing significant mass effect and moderate hydrocephalus. Serology was negative, and systemic imaging ruled out extracranial involvement. The patient underwent parieto-occipital craniotomy, and the cyst was excised intact using the Dowling-Orlando technique to prevent rupture. Histopathology confirmed hydatid disease. Postoperatively, albendazole (10 mg/kg) was administered for 30 days along with anticonvulsants. Recovery was uneventful, and follow-up imaging showed no recurrence. This case underscores the importance of early recognition, meticulous surgical planning, and postoperative monitoring for successful outcomes in cerebral hydatid disease, particularly in endemic areas.