Secondary Optic Atrophy Research Articles

Unilateral Orbital Compartment Syndrome with Cavernous Sinus Thrombosis after Prolonged Prone Position Anaesthesia for Spinal Surgery

Orbital compartment syndrome is a rare but preventable cause of blindness. A 42 year male patient, a case of accidental fracture cervical spine and quadriplegia underwent cervical spine surgery under general anaesthesia. Surgery was performed with patient in prone position on a padded horse shoe stand for 4 hours duration.Proptosis, redness and chemosis of right eye was noticed 3 hours after recovery from general anaesthesia. The affected eye was stony hard with corneal oedema, fixed dilated pupil, total ophthalmoplegia and absent perception of light. Other eye was unaffected. An urgent canthotomy and cantholysis was done and topical as well as systemic antiglaucoma treatment instituted along with systemic and topical antibiotics. A contrast-enhanced computed tomography, done the next day revealed anterior displacement with posterior tenting of right globe and bilateral cavernous sinus thrombosis. Proptosis and swelling subsided gradually without any recovery of vision. Generalised retinal atrophy and secondary optic atrophy was seen 3 weeks post surgery.

Diagnostic value of optical coherence tomography for intracranial pressure in idiopathic intracranial hypertension

Background Idiopathic intracranial hypertension (IIH) is a condition of raised intracranial pressure (ICP) in the absence of space-occupying lesions or other known etiology. It primarily affects young obese females, and potentially causes permanent visual loss due to papilledema and secondary optic atrophy. The aim of this study was to evaluate the diagnostic value of optical coherence tomography (OCT) as a marker for CSF opening pressure in patients with idiopathic intracranial hypertension (IIH).

Large and giant vestibular schwannomas: does cisterna magna hyperproteinorrhachia influence visual status?

Hyperproteinorrhachia associated with vestibular schwannomas (VSs) may influence visual status independent of the effect caused by raised intracranial pressure. The role of cisterna magna CSF protein levels (CMCP) in determining visual outcome in patients with large to giant vestibular schwannomas (VSs) was prospectively investigated. The mean CMCP levels in VSs and control group; and, levels in VSs with or without visual deterioration were compared. Spearman's rank correlation coefficient tested for relationships between CMCP level with symptom duration and tumour volume (Kawamoto's method). Vision was regarded as normal when visual acuity was >6/18; and, deteriorated when it was between 6/18 and PL negative in the worse eye. Papilloedema (n = 26)/secondary optic atrophy (n = 6) and hydrocephalus (based on Evan's ratio, mild to moderate: n = 22; none: n = 18) were also recorded. The analysis of factors predicting diminished vision was done using logistic regression analysis (p < 0.05 significant). There was a significant difference (p < 0.001) in mean CMCP levels between VS (456.3 SD 213.6mg/dl) and control groups (96.3 SD 74.3mg/dl). The mean CMCP levels in the VS group were also markedly higher than the ventricular mean protein levels. The CMCP levels in patients with visual diminution (<6/18 to PL negative; n = 23) was 561.4 SD 186.9mg/dl and those without visual loss (n = 17) was 314.2 SD 160.8mg/dl (p < 0.001). Their grade of visual diminution had a positive correlation with mean CMCP levels (p < 0.001). There was a negative correlation between total duration of symptoms and CMCP levels (p < 0.015). Logistic regression analysis using five independent factors (symptom duration, papilloedema/secondary optic atrophy, tumour volume, hydrocephalus and mean CMCP level) revealed that only CMCP level had a significant association with visual diminution. Elevated cisternal CSF proteins may play an important role in determining visual outcome in large to giant VSs. Ventricular CSF analysis is often unable confirm the presence of VS-associated cisternal hyperproteinorrhachia. High CMCP levels may influence decision-making while instituting a permanent CSF diversion for postoperative hydrocephalus or recalcitrant pseudomeningocoele.

Addison’s Disease, Idiopathic Intracranial Hypertension and Empty Sella - In a 40-Year-Old Woman

A 40-year-old woman having normal menstrual history got admitted into Bangabandhu Sheikh Mujib Medical University (BSMMU) because of vomiting for previous two months, with a background history of irregular steroid intake for her bodyache for about six years. She was gaining weight and gradually losing vision in her right eye and noticed increased body pigmentation. Physical examination revealed BMI 29 kg/m2, generalized pigmentation more marked in palmar crease and oral mucosa, secondary optic atrophy in right eye and papilloedema in left eye. After biochemical and radiological investigation she was diagnosed as a case of Addison’s disease with idiopathic intracranial hypertension (IIH) with empty sella DOI: http://dx.doi.org/10.3329/jbcps.v30i1.11368 J Bangladesh Coll Phys Surg 2012; 30: 53-55

Diagnostic value of optical coherence tomography for intracranial pressure in idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH) is a condition of raised intracranial pressure (ICP) in the absence of space-occupying lesions or other known etiology. It primarily affects young obese females, and potentially causes permanent visual loss due to papilledema and secondary optic atrophy. The aim of this study was to evaluate the diagnostic value of optical coherence tomography (OCT) as a marker for CSF opening pressure in patients with idiopathic intracranial hypertension (IIH). We conducted a case-control study of 20 newly diagnosed, 21 long-term IIH patients, and 20 healthy controls. Investigations included measurement of peripapillary retinal nerve fiber layer thickness (RNFLT) and total retinal thickness (RT), automated visual field testing, and measurement of CSF opening pressure. An OCT elevation diagram was developed as a new diagnostic tool. The diagnostic ability of OCT as a marker of increased ICP (> 25 cmH(2)O) was investigated using multiple regression and receiver operating characteristic (ROC) curves. OCT elevation diagrams showed that in 60 % of patients newly diagnosed with IIH and in 10 % of patients with long-term IIH, 50 % or more of the OCT scans (RT and RNFLT) were above normal. The percentage of abnormal OCT scans was significantly associated with increased ICP (p < 0.0001). Estimated areas under the ROC curves increased from 77.1 to 86.9 by including OCT in multiple regressions. Autoperimetry pattern standard deviation was significantly increased (p = 0.0005) and mean deviation was significantly decreased (p = 0.0005) in IIH patients as compared to healthy controls. Increased peripapillary retinal thickness measured by OCT is associated with increased ICP in newly diagnosed IIH patients. OCT may thus serve as a valuable supplement to subjective assessment of papilledema in patients suspected of having IIH. In long-term IIH patients who have previously been treated, OCT appears to be of limited value in predicting ICP.

Neurological Complications Following Pediatric Liver Transplant

We studied neurological complications (NCs) after liver transplantation (LT) in children. We performed an institutional review board-approved retrospective review of patients with LT ≤21 years during a period of 30 years (1980-2010). NCs were classified as early (within 3 months post-LT) and delayed (beyond 3 months post-LT). Of 65 children with LT, 20 (30.7%) had NCs; 16 were girls. Mean age was 11.8±5.9 years. Early NCs were found in 13.8% (9/65) of the patients: seizures in 7 and encephalopathy in 2. Abnormal neuroimaging findings were posterior reversible leukoencephalopathy syndrome (1), intracranial hemorrhage (1), mild cerebral edema (1), and bilateral basal ganglia T1W hyperintensities in magnetic resonance imaging (1). On follow-up, there were 3 deaths (unrelated to NCs). One with intracranial hemorrhage had residual hemiparesis and was taking a long-term antiepileptic drug. Late NCs are found in 16.9% (11/65) of the patients: seizures in 4, headache in 4, encephalopathy in 3 (1 had seizures in addition), and paresthesias caused by possible small-fiber neuropathy in 1. Abnormal neuroimaging findings were hypoxic-ischemic encephalopathy (1), encephalomalacia caused by old hemorrhage (1), and hyperintensity of the posterior periventricular white matter in magnetic resonance imaging (1). On follow-up, all of the patients survived; 1 had papilledema with secondary optic atrophy requiring optic nerve sheath fenestration and 1 needed long-term antiepileptic drug. NCs are common in children after LT, seizures being the most common. In contrary to the previous studies, we found delayed complications more often than early complications. Early detection and appropriate management of NCs is important.

Clinical guidelines for diagnosing and managing ocular manifestations in children with mucopolysaccharidosis

The mucopolysaccharidoses (MPS) are a group of rare lysosomal storage disorders characterized by the accumulation of glycosaminoglycans in several tissues and organs. This accumulation results in an array of clinical manifestations and premature death in severe cases. Ocular problems are very common in children with MPS and may involve the cornea, sclera, trabecular meshwork, retina, optic nerve and also the posterior visual pathways. The aims of this study are to give an overview of ocular problems in MPS and to provide clinical guidelines for paediatric ophthalmologists for early diagnosis and management of ocular manifestations in children with MPS. Diagnostic problems may arise in children with severe corneal clouding, hampering visualization of the fundus. Intraocular pressures may be falsely high, even leading to suspicion and unnecessary pressure-lowering treatment. Simple interventions such as the use of prescription glasses or photochromatic glasses can considerably improve quality of life in children with MPS.

Choroidal Infarction in Fulminant Idiopathic Intracranial Hypertension

We report a unique case of idiopathic intracranial hypertension (IIH) in which vision loss likely occurred from a variety of mechanisms, including an acute choroidal infarction. A 20 year-old white woman complained of severe headaches with nausea, photophobia and pulsatile tinnitus. For the past week, she had noticed rapidly progressive visual loss in both eyes with severe constriction of her peripheral visual field. Review of systems was remarkable only for recent weight gain of 20 pounds over the previous year. On examination, body mass index was 26.6, blood pressure was 110/68 mmHg, and neurologic examination was normal. Visual acuity was 20/20 in the right eye and 20/30 in the left eye. Humphrey and Goldmann visual fields showed bilateral constriction with an inferior nasal defect and enlarged blind spot in the right eye and an inferior altitudinal defect in the left eye. Funduscopic examination (Figure 1) showed bilateral severe optic nerve head edema with peripapillary hemorrhages and white nerve fiber layer infarctions. In the left eye, there was an area of juxtapapillary whitening extending to the macula, which appeared deep in the retina or subretina. A fluorescein angiography (FA) showed normal choroidal, arterial and venous filling 25 seconds after injection of fluorescein and normal retina (no mask effect, no edema), ruling out a branch retinal artery or cilioretinal artery occlusion (Figure 2a). Indocyanine green (ICG) videoangiography (figure 2b) demonstrated a choroidal perfusion defect matching the white patch seen in the left ocular fundus, confirming a choroidal infarction. Figure 1 Fundus photography (the right eye is shown on the left and the left eye is shown on the right) showing bilateral optic nerve edema with white exudates. In the left eye, there is an area of whitening extending to the macula and located deeper than the ... Figure 2 (a) Fluorescein angiography of the left eye 25 seconds after injection of fluorescein showing normal retinal vascular filling (earlier transit times were not shown and choroidal filling could not be evaluated); (b) Indocyanine angiography of the left ... We believed the patient's clinical presentation was highly suggestive of raised intracranial pressure (ICP) with severe papilledema complicated by a choroidal infarction in the left eye, and probably also a superimposed anterior ischemic optic neuropathy (AION) in the left eye, given the inferior altitudinal defect. The diagnosis of IIH was confirmed by normal brain magnetic resonance imaging (MRI) and brain magnetic resonance venography (MRV), and elevated CSF opening pressure (560 mm of water) with normal CSF contents1. Diagnostic lumbar puncture relieved her headaches immediately and she was begun on oral acetazolamide 500mg twice a day. Her visual function, however, remained poor and she underwent bilateral sequential optic nerve sheath fenestrations (ONSF) (left eye first) 8 and 21 days later. The headaches did not recur, and her visual function improved over time, especially in the right eye. The disk edema resolved and she developed secondary optic atrophy. The juxtapapillary whitening resolved within two weeks of the ONSF. Her altitudinal defect remained unchanged in the left eye and her visual field improved in the right eye, but remained constricted (Figure 3). Final visual acuity was 20/20 in both eyes. Figure 3 Humphrey visual fields (24-2 SITA Fast) after ONSF showing persistent constriction and a small paracentral scotoma above fixation in the left eye corresponding to the choroidal infarction.

Pinealoblastoma with prominent retinoblastic differentiation: An unusual case in an adult

We present an extremely rare case of pinealoblastoma with retinoblastic differentiation in a 32-year-old woman who presented with a history of intermittent headache of 2 years duration and diminution of vision for 2 months which eventually lead to total loss of vision. The fundus examination showed bilateral secondary optic atrophy. She did not have any previous history of retinoblastoma. The family history was non-contributory. Paraffin section of the tumor showed a primitive neuroectodermal tumor with numerous Flexner-Wintersteiner rosettes and the tumor cells were strongly positive for synaptophysin and negative for GFAP, S-100 protein and epithelial membrane antigen. This is the first case in the literature of a sporadic case of pinealoblastoma with prominent retinoblastic differentiation as evidenced histomorphologically by the presence of numerous Flexner-Wintersteiner rosettes in an adult female.

Pediatric colloid cysts of the third ventricle: management considerations

Pediatric colloid cysts (CC) have a congenital origin, and yet, there are very few studies focussing exclusively on their occurrence in the pediatric population. Pediatric CC has been associated with more aggressive clinical and radiological patterns than their adult counterparts. In this study, undertaken on children with anterior third ventricular CC, excised using the interhemispheric transcallosal approach, the characteristic clinicoradiological features and management options are studied. Five pediatric patients (aged 16 years or less; mean age 13.8 years; mean duration of symptoms:7.6 months) out of 38 patients with CC operated between 1995 to 2009 were included. The clinical manifestations included those of raised intracranial pressure (n = 4); exacerbation of occipital headache on reading (n = 1); secondary optic atrophy (n = 3); and, drop attacks (n = 1). On computed tomography scan, the cyst was hyperdense, enhancing in two patients and not enhancing in three patients. All had bilateral lateral ventricular dilatation with periventricular lucency. On magnetic resonance imaging (n = 3), the cyst was T1 hypointense and T2 isointense in one, hyperintense on both T1 and T2 with a hypointense capsule and nonenhancing on contrast in one (with a giant colloid cyst), and T1 hyperintense and T2 hypointense in one patient. An interhemispheric, transcallosal trajectory combined with transforminal approach (n = 3); combined transforminal and subchoroidal approaches (n = 1); and, interforniceal approach (n = 1) were used. Total excision was performed in four patients. In one patient, a small part of capsule was left attached to thalamostriate vein. Symptoms of raised intracranial pressure showed improvement in all the patients with resolution of hydrocephalus. There was no tumor recurrence at follow-up. Pediatric colloid cysts are rarer than their adult counterparts due to their late detection only after manifestations of raised intracranial pressure, visual or cognitive dysfunction or drop attacks occur. Their radiological appearance varies depending upon the amount of mucoid content, cholesterol, proteins, and water content. The fast development of clinical manifestations in children may be related to rapid enlargement of cyst due to higher water content within them. The transcallosal approach is the "gold standard" of surgery and usually ensures gratifying and lasting results.

Primary choroid plexus papilloma of the sellar region

Choroid plexus papillomas are rare tumors of the central nervous system and are usually confined to the ventricle system. We describe a choroid plexus papilloma located in the sella turcica that was identified pathologically. A 49-year-old woman with a 5-year history of progressive visual deterioration in the left eye was admitted to our hospital. Neurological examination found no abnormality except for the perception of light and secondary optic atrophy in her left eye. Careful endocrine testing did not show any hormone excess or deficiency of the pituitary and target glands. Magnetic resonance imaging demonstrated a hemorrhagic mass in the sellar region, which occupied the entire sella turcica and extended to the suprasellar cistern. The mass was excised via an endonasal trans-sphenoidal approach. Histologic examination proved that the lesion was a choroid plexus papilloma. Choroid plexus papillomas arising in and occupying the sella are rare, although some radiographic patterns of ectopic choroid plexus papillomas have been reported. A review of the current literature revealed no similar cases of a choroid plexus papilloma. We discuss the different radiological appearances of choroid plexus papillomas, the differential diagnosis, and treatment.

Visual dysfunctions and ocular disorders in children with developmental delay. I. prevalence, diagnoses and aetiology of visual impairment

To describe the prevalence, diagnoses and aetiologies of visual impairment in children with developmental delay (DD) in a Danish county with a population of 618 000 citizens. We carried out a cross-sectional study in Copenhagen County of children aged 4-15 years with profound to borderline DD (IQ <or= 80). Children were located through school psychologists or paediatric clinics. The number of children with DD was estimated using the capture-recapture method. A total of 1126 children fulfilled the inclusion criteria, corresponding to 97.7% of the estimated number of children with DD in the county. Ophthalmological examinations were performed in 923 children. The prevalence of visual impairment was 10.5% in the study group and 22.4% in those with an IQ <or= 50. The diagnoses were predominantly cerebral visual impairment, optic atrophy, retinal dystrophies and congenital nystagmus. The aetiology of visual impairment was prenatal in 54 children, perinatal in 29 children and postnatal in seven children. Visual impairment is highly increased in children with DD and is correlated to low IQ.

Massive Congenital Orbital Teratoma

Orbital teratomas are rare embryonic tumors composed of a wide diversity of tissues derived from the three germinal layers. The presenting features include, a healthy newborn with extreme unilateral proptosis; marked stretching of the eyelids over a tense, fluctuating mass, with elongation of the palpebral fissure; enlargement of the bony orbit (two to three times normal size) with subsequent nasal and malar deformities; and transillumination of all or part of the orbital mass. Commonly the eye is normally developed but often vision is not preserved either due to exposure or secondary optic atrophy. The objective in the management of orbital teratoma is to save the eye to encourage orbitofacial development, maintain cosmesis and retain some vision. We report a case of massive congenital orbital teratoma successfully removed by an eyelid-sparing exenteration technique.

Complications of traditional couching in a Nigerian local population

To evaluate the complications of traditional couching in a local population. New patients who had undergone couching and presented to the consultant outpatient clinic of the University of Benin Teaching Hospital and D.D.S. Eye clinic in Benin-city between April 2002 and March 2003 were interviewed and examined by the author to identify the complications. Eighteen eyes of 14 patients who had undergone couching were seen in Benin-city over a 1 year period. The cost of couching was similar to modern cataract surgery. Ten patients (71.42%) were initially satisfied but later became unsatisfied because of the complications and 2 (14.29%) were unsatisfied with the procedure. The main reasons for opting for couching were ignorance and fear of surgery. The main complications were secondary glaucoma (61.54%), hyphaema (15.38%) and optic atrophy (15.38%). Visual acuity of no light perception was seen in 33.33 % of eyes mainly from secondary glaucoma but 50% of eyes had corrected visual acuity of 6/18 or better. In view of the above complications, traditional couching should not be encouraged.

Enigma of raised intracranial pressure in patients with complex craniosynostosis: The role of abnormal intracranial venous drainage. Taylor WJ, Hayward RD, Lasjaunias P, Britto JA, Thompson DNP, Jones BM, Evans RD. J Neurosurg 2001;94:377–385.

Raised intracranial pressure (ICP) may complicate all forms of craniosynostosis. Several factors have been associated with increased ICP in patients with craniosynostosis, including craniocerebral dysproportion, hydrocephalus, the secondary effects of respiratory obstruction, and venous hypertension. In rare, but well-recognized instances, raised ICP can cause papilledema leading to secondary optic atrophy, reduced visual field and visual acuity, and even blindness. In this study, the authors investigated whether patterns of intracranial venous drainage in children with complex craniosynostosis associated with raised ICP were abnormal and, thus, could support the theory that venous hypertension is a major contributor to raised ICP in these patients, putting them at risk for impaired visual function. The authors analyzed the anatomy of intracranial venous drainage as demonstrated on 24 angiography studies from 23 patients, all of whom had either a craniosynostosis-related syndrome (18 patients) or a nonsyndromic multisutural synostosis (five patients). Twenty-one patients had evidence of raised ICP one to six weeks before undergoing angiography. Of the two remaining patients whose ICP monitoring was normal immediately before angiography, each had undergone two previous cranial vault expansion procedures. In 18 angiography studies, a 51% to 99% stenosis or no flow at all could be observed in the sigmoid-jugular sinus complex either bilaterally (11 patients) or unilaterally (seven patients). In 11 of these patients a florid collateral circulation through the stylomastoid emissary venous plexus was also seen. Comparison of two angiography studies performed in one patient with Crouzon syndrome demonstrated a progression of the abnormal venous anatomy. There was no obvious correlation between each patient’s baseline ICP and the degree of abnormality of their venous anatomy. The authors assert that in children with complex forms of craniosynostosis in whom other factors, such as hydrocephalus, are absent, abnormalities of venous drainage that particularly affect the sigmoid-jugular sinus complex produce a state of venous hypertension, which in turn, is responsible for the majority of cases of raised ICP. The incidence of these changes is unknown, but an analysis of the ages of the children in this study indicated that the period of particular vulnerability to the effects of venous hypertension lasts until the affected child is approximately six years old. After that age the collateral venous drainage through the stylomastoid plexus will likely become sufficient to allow ICP to normalize.—Nancy J. Newman

Use of scanning laser ophthalmoscopy to monitor papilloedema in idiopathic intracranial hypertension

AIMSTo determine the sensitivity of confocal scanning laser ophthalmoscopy (SLO) in detecting clinically significant changes in papilloedema secondary to idiopathic intracranial hypertension (IIH) and the correlation with visual field loss.METHODSEight...

Severe Optic Disc Edema Without Hydrocephalus in Neurofibromatosis 2

A 26-year-old man who had neurofibromatosis type-2 with symptoms of unexplained optic disc edema is reported. Magnetic resonance imaging (MRI) revealed bilateral acoustic schwannomas. Obstructive hydrocephalus, however, was not evident in spite of his severe disc edema and visual loss. After partial removal of the right acoustic schwannoma, symptoms of intracranial hypertension, such as vomiting and headache, developed and MRI demonstrated evidence of obstructive hydrocephalus. Placement of a ventricular-peritoneal shunt relieved the symptoms of intracranial hypertension, but visual acuity in his left eye was reduced to hand motion due to secondary optic atrophy. In patients with similar symptoms it is suggested that, in addition to tumor removal, early treatment to decrease intracranial pressure should be considered when visual function is progressively impaired by the symptoms of prolonged papilledema.

Atypical response to chemotherapy in neurotuberculosis

Five cases of intracranial tuberculosis with atypical response to antitubercular chemotherapy are reported. In these cases tuberculomas either increased in sizes or first developed during course of adequate chemotherapy for tubercular meningitis or postmeningitic hydrocephalus. In two of these cases granulomas were located deeply in the parenchyma; however, these were on the surface in the other three. Atypical response to antitubercular treatment was observed at 5 weeks, 8 weeks, 2 months (in two cases) and 6 months. Glucocorticoid therapy was instituted in two cases and surgical excision of tuberculomas performed in the others. Recovery was good in all the five cases excluding visual loss, which remained unchanged in two cases because of prexisting secondary optic atrophy.

Incidence of registered visual impairment in the Nordic child population.

A collaborative, population based, prospective register study on the incidence of visual impairment in children during the year 1993 was carried out in five Nordic countries with a total population of 17 million inhabitants. The child population was 3.8 million individuals aged 0-17 years. The following variables were taken into account: nationality, age, sex, diagnoses, aetiology, degree of visual impairment, and additional impairments. Classification routines from an earlier prevalence study were used. The present study included 304 children corresponding to an incidence of notification of 8/100,000 children, varying from 5.7 to 11.1 in the five countries. Fifty per cent of the visually impaired children were reported before they were 3 years of age. In approximately 45% of the children, visual impairment was due to various brain disorders, with cerebral amblyopia and secondary optic atrophy as the two leading causes. The relative impact of retinopathy of prematurity had decreased from the third most frequent cause (10%) in the prevalence study to seventh place (4%) in the incidence study. Two thirds of the children had additional impairments and these children also suffered from the most severe visual impairments. Among aetiological factors the majority (64%) were prenatal. The overall male:female ratio of 1.4:1 was identical to the sex ratio of the prevalence study.

Intracranial Hydatid Cysts in Children

Brain involvement in hydatid disease occurs in 1 to 2% of all Echinococcus granulosus infections. Fifty to 75% of intracranial hydatid cysts are seen in children. This study included 19 children who underwent surgery for intracranial hydatid cysts between January 1979 and September 1992. There were 12 boys and 7 girls, ages 3 to 16 years (mean, 8.1 yr). Headache and vomiting were the predominant symptoms. Papilledema was present in 16 patients, and 2 patients had secondary optic atrophy. A round, cystic lesion without perifocal edema and rim enhancement was detected on the computed tomographic scans of 13 patients. The cystic lesions with rim enhancement and perifocal edema were noted on the computed tomographic scans of 3 patients. Of these three patients, two subsequently had a recurrence. Total removal of the cyst without rupture was achieved in 12 patients. Only a 3-year-old boy in whom the cyst ruptured at surgery died. Seven patients in whom either the hydatid cyst ruptured at surgery or there was systemic hydatid disease received mebendazole therapy. Mebendazole seems to be effective in hydatid disease. Cerebral hydatid cysts should be removed in toto without rupture. The preoperative diagnosis is very important in planning surgery. When a cystic lesion is detected on computed tomographic scan, hydatid disease should be taken into consideration in countries where hydatid disease is endemic.