Anesthetic management of a pediatric patient during surgical excision of primary cerebral hydatid cyst

Abstract

Hydatid cysts develop in humans with the transmission of Echinococcus Granulosus or more rarely Echinococcus Multilocularis. The disease develops in the liver 50-75%, and in the lungs 15-35% of the cases. Intracranial hydatid cyst is seen 0.5-3% of the cases. In this case report, we aimed to present the anesthetic approach and possible anaphylactic reaction in a giant primary intracranial hydatid cyst. A five years and eight months old boy (19 kg, 114 cm) was admitted to the emergency room with complaints of a headache, nausea, vomiting, and deviation of the eyes for about 1 month. Fundus examination revealed bilateral disc elevation and severe papillary edema. Cranial magnetic resonance imaging showed a large hydatid cyst in the right parietal lobe. The patient was scheduled for craniotomy by the neurosurgeons. After induction and endotracheal intubation, 1 mg.kg-1 pheniramine hydrogen maleate and 1 mg.kg-1 methylprednisolone were administered as a protective measure against anaphylaxis. The cyst excised by Dowling method, and no rupture observed. The patient, who did not have any perioperative complication, was extubated and followed in the intensive care unit of neurosurgery department. Cerebral hydatid cyst is rare and usually seen in children. This could be explained by the presence of right-to-left shunts. The gold standard in the treatment of cerebral hydatid cysts is surgical removal. In order to prevent recurrence and anaphylactoid reaction, the cyst should be removed without rupturing it. The hemodynamic changes with cyst rupture are seen milder in the patients receiving prophylactic treatment.