Le Kyste Hydatique Cerebral :A Propos De 104 Cas

Abstract

Description Le kyste hydatique est une anthropozoonose causee par l\'Ecchinococcus granulosis, ayant pour hote definitif le chien. L\'homme est affecte accidentellement. Sa localisation cerebrale est rare et pose de veritables problemes therapeutiques lorsqu\'elle est multiple. Objectifs Mettre en lumiere les particularites et les difficultes rencontrees dans la prise en charge de la localisation cerebrale de cette affection, par notre experience basee sur 104 cas de kyste hydatique cerebral. Resultats La majorite des patients etait âge de moins de 15 ans, avec une predominance masculine. La forme de presentation clinique etait le syndrome d\'hypertension intracrânienne et un deficit neurologique focal. L\'examen paraclinique cle du diagnostic est la TDM cerebrale, qui apporte des elements diagnostic non de certitude, mais de forte orientation. La serologie hydatique est un autre element orienteur, mais il est rarement positif. L\'IRM cerebrale peut etre utile pour faire le diagnostic differentiel avec les autres processus tumoraux cerebraux. Tous les patients ont beneficie d\'un traitement chirurgical par expulsion forcee du kyste en introduisant de solution saline hypertonique autour et sous le kyste selon la technique d\'Arana-Iniguez. Les suites postoperatoires ont ete marques par la recuperation du deficit neurologique chez 90% des patients et 2 cas de recidive a 22 et 30 mois respectivement. 2 patients ont garde des sequelles a type de cecite bilaterale. Conclusion La localisation cerebrale du kyste hydatique est rare et de bon pronostic, pour peu que la prise en charge soit precoce et qu\'il n\'y ait pas d\'autres localisations cerebrales ou viscerales associees. Description Hydatid cyst is an anthropozoonosis caused by Ecchinococcus Granulosis, that affect dogs. Human being is affected accidentally. It cerebral location is rare and leads to a serious therapeutic difficulties in a case of multiple location. Goals Highlight the particularities and difficulties encountred in managing cerebral hydatid cyst through our experience based on 104 cases of cerebral hydatid cyst. Results The majority of the patients were under 15 years old, with the male predominance. Clinical presentation was often increase intracranial pressure syndrome, associated with focal neurologic deficit. The main diagnostic tool was cerebral CT-scan, which permit to suspect the diagnosis in all the patients. Hydatic serology was rarely positif, and it permitted to suspect the diagnosis when associated with intracranial cystic lesion. Cerebral MRI, can be used for differential diagnosis. All the patient underwent surgical treatment by forced cyst expulsion with the introduction of hypertonic saline solution under and around the cyst, known as Arana-Iniguez technique. Postoperative course was noted down by neurologique recovery in 90% of the patients and 2 cases of reccurrences at 22 and 30 months postoperative. 2 patients remind with sequelas as bilateral blindness. Conclusion rare affection with good prognosis, when the diagnosis and treatment are precocious and no other cerebral or visceral locations Keywords : Hydatid cyst - Cerebral location - Surgery African Journal of Neurological Sciences Vol. 26 (1) 2007: pp. 21-26