History of Management of Echinococcal Infections of the Central Nervous System in Children

Understanding of Disease

• Hippocrates described hydatidosis: Hydatidosis was first described by Hippocrates (460-377 BC) (2).
• 1782 – Gorze described cyst contents: In 1782, Gorze determined that the cysts contain tapeworm heads with suckers and hooklets (2).
• 1862 – Naunyn described life cycle: The life cycle of the parasite was identified by Naunyn in 1862 as being a chain from the feces of carnivores to humans (2).
• 1866 – Virchow described alveolar form of disease: In 1866 Virchow described the alveolar form of the disease; the hydatid sand of the cyst liquid is composed of scolices (the fundamental elements in the formation of the hydatid cysts), brood capsules, and hooklets together. A cubic centimeter of hydatid fluid contains up to 400,000 scolices, thus being capable of producing 400,000 hydatid cysts (2).

Technological Development

• Endoscopy: Endoscopy is beneficial in the evacuation of spinal cysts (50).
• Gamma knife radiosurgery: Gamma knife radiosurgery is suggested as an alternative technique in the treatment of cerebral hydatid cysts (51).

Surgical Technique

• Dowling’s technique: The most commonly used technique in hydatid cyst resection to date was initially described by Dowling in 1929 (9, 52).
• PAIR technique: The steps in the PAIR technique are as follows: Puncture of cyst, Aspiration of cyst contents, Injection of an antiscolicidal solution, and Re-aspiration. This technique is not commonly used for CNS hydatid cysts (53).