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