Hydatid cyst of the medulla oblongata: rare presentation and surgical management

• Rare hydatid cyst in medulla oblongata reported. • PAIR technique enabled safe cyst removal. • Histology confirmed hydatid disease diagnosis. • Albendazole ensured stable postoperative outcome. Hydatid disease is a zoonotic parasitic infection that typically involves the lungs and liver. Primary intracranial cysts, especially in the brainstem, are extremely rare and rarely reported. We present a complex case of a brainstem hydatid cyst in a patient with a history of aqueductal stenosis and ventriculoperitoneal shunt placement, successfully managed with surgical intervention. A 28-year-old woman with a history of aqueductal stenosis and prior ventriculoperitoneal shunt surgeries presented with an 18-month history of headache, dysarthria, dysphagia, ataxia, and dysmetria. Neurological examination confirmed cerebellar signs. A brain MRI revealed a well-defined cystic lesion in the medulla oblongata. Hydatid disease was suspected, even though serology and abdominal imaging were negative. The lesion was surgically treated using a modified PAIR (Puncture, Aspiration, Injection, and Re-aspiration) technique. The diagnosis of hydatid cyst was confirmed by histopathological examination. We have administered postoperative antiparasitic therapy, and the patient showed marked clinical improvement and a stable situation at six-month follow-up. Our case describes the rare occurrence of a hydatid cyst in the brainstem. We emphasize the need to consider hydatid disease in the differential diagnosis of brainstem lesions, particularly in endemic regions, and underscore the diagnostic and therapeutic challenges associated with such unusual presentations.