Hydatidosis of central nervous system and its coverings in the pediatric and adolescent age groups in Turkey during the last century: a critical review of 137 cases.

INTRODUCTION: Hydatid disease is still a major problem in infested areas of the world, especially in the rural areas, including Turkey.
OBJECTIVE: The objective of this review was to analyze the literature on the management of central nervous system (CNS) hydatidosis with an emphasis on their specificities in childhood and adolescence, with the aim of determining the clinical and neuroradiological findings and treatment modalities, medical or surgical, in these age groups.
MATERIALS AND METHODS: To establish some guidelines for the diagnosis and treatment of this controversial condition, publications reported from Turkey in national ( n=33) and international ( n=55) journals during the last century and databases containing medical literature were used. Strikingly, the numbers of articles produced by Turkish authors on CNS hydatidosis have risen tremendously during the study period. Although a total of 272 cases of intracranial and intraspinal hydatid cysts were reported from Turkey, only 137 cases for which detailed information was available were selected for further analysis, in keeping with our inclusion and exclusion criteria. RESULTS AND DISCUSSION: Despite the inherent limitations, this type of study indicates that the incidence of hydatidosis has not decreased in Turkey in recent years. The clinical findings were mostly atypical, and it was interesting that 4 patients were described as having cerebrovascular occlusive disease and 3 as having symptoms of movement disorders. Computed tomography and/or MRI techniques were extremely useful, both in reaching the correct diagnosis and for proper surgical management of hydatid disease, because of the absence of a pathognomonic clinical picture of this disease. The treatment of choice for hydatid disease of the CNS and its coverings was complete intact removal of the cyst. In contrast to that in intracranial hydatid cysts, however, surgical intervention was palliative, not curative, in almost all cases of intraspinal hydatidosis. According to this critical review of the literature, CNS hydatidosis is therefore still a life-threatening condition, in spite of all the advances in imaging techniques and therapeutic methods. The most important factors in prognosis are the localization of the focus of infection, rupture and of the cyst and dissemination of its content, and treatment modality. At present, surgical intervention preceded by careful neuroradiological evaluation remains the best surgical therapy, and this plus adjuvant chemotherapy is advocated in some cases as the gold standard for therapy.