Cerebral hydatidosis: a reappraisal

The remarkable evolution of surgical management of cerebral hydatidosis towards an earlier diagnosis and proper treatment is evident from this 22-year retrospective study of our experience with 19 cases seen at Shiraz University Medical Institutions. Both cases of iatrogenically-induced infected cysts were seen during the pre-CT era. The optimistic view of being able to remove all the cysts intact seems to be elusive because six cysts ruptured during extraction even with application of the Dowling technique. These cases were followed for a mean of 44 months and in only one case was the patient referred again with subarachnoid cysts of the lumbosacral region after two years. In six cases we had involvement of other organs also. There were two cases of multiple cysts in the brain, a case with de novo infection of the cyst contents, and one in which the cyst was epidural in the parieto-occipital region. One patient died pre-operatively and three were lost to follow-up; however, fifteen patients were followed for a mean of 27 months with eleven being neurologically intact and four with focal neurological deficits. One patient with a tapped cyst before extraction was readmitted two years later with paraplegia due to drop parasitic infestation of the thoracolumbar region

Intradural extramedullary hydatid cyst: report of four cases

Progressive myelopathy was noted in three and an incomplete cauda equina syndrome in a fourth patient with intradural extramedullary hydatid cysts. In three patients the presence of medullary cysts were thought to be "de novo", but in one was a consequence of an intra-operatively ruptured cerebral cyst two years previously. Surgical exploration was modestly successful in relieving the symptoms. In at least three patients there was involvement of lung and liver with multiple cysts

Surgical mortality in 913 who sustained missile head wounds during the Iran-Iraq war

Surgical mortality was studied in 913 patients with missile head wounds evacuated to Nemazee Hospital over a 95-month period. One hundred and twenty six patients died in this series [13.8%]. Thirty-five of 412 patients [8.5%] with primary exploration [Group A] and 57 of 277 patients [20.5%] with secondary exploration [Group B] in Shiraz expired post-operatively. Mortality in 224 patients with a primary exploration at a base hospital was 15% [Group C]. The type of projectile, the site of injury over the skull, and intracranial hematomas were not statistically determinant on mortality. Penetrating projectiles crossing into a second dural compartment or having a perforating mode of injury had a significant bearing on mortality. In patients with a Glasgow Coma Scale score of 13-15, 9-12, 4-8 and 3, the mortality was 3.3, 14, 44.3 and 100 percent. Of the patients who died in this series, 71.4% had a Glasgow Coma Scale score of 3-8. Eighteen patients in Group A [4.4%], 43 in Groups B [15.5%], and 30 in Group C [13.4%] developed CNS infection. Forty of 91 patients [44%] with CNS infection died

Chiasmatic syndrome due to extramedullary hematopoiesis in beta thalassemia

A 21 year-old man with homozygous beta thalassemia noted gradual deterioration of his vision over a period of five years resulting from a chiasmatic syndrome. The difficulty with visual perception did improve with timely blood transfusion as required once every few weeks in these patients. An enhancing tumor on CT of head turned out to be a mass of extramedullary marrow upon trans-sphenoidal exploration. Postoperative low dose radiation resulted in a modest degree of improvement of his visual acuity over a six year period