Management of Echinococcal Infections of the Central Nervous System in Children

Initial Management at Presentation

• Hydrodissection of brain cyst: Because it yields the lowest rates of mortality and morbidity, the Dowling-Orlando technique is the most frequently applied method for surgical treatment of hydatid cysts. It involves the hydrodissection of the cyst-brain interface by gentle irrigation with soft-tipped catheters (9).
• PAIR technique for eloquent areas of brain: Another surgical technique described in the literature and used in problematic, non-CNS cases is the PAIR tapping procedure, i.e., puncture with a needle followed by aspiration during surgery. In the case of deep-seated and tightly surrounded cysts that cannot be removed by irrigation, the entire content of the cyst is aspirated, and the collapsed cyst is lifted away.
• Wide excision followed by chemotherapy for spine disease: Radical surgery is the keystone of treatment, but complete removal of spinal hydatid cysts is rarely accomplished in a single operation. Surgery is followed by treatment with oral albendazole.

Adjunctive Therapies

• Oral albendazole: Albendazole is a broad-spectrum antihelminthic agent with good oral absorption that blocks glucose uptake, depletes the glycogen stores, and thus immobilizes and kills the parasite, but it may be hepatotoxic (6).

Follow-up

• Follow-up visits and imaging: MRI is obtained 3 months after surgery followed with clinical visits at 3 months and 1 year after surgery.