Intracranial hydatid cysts: A systematic review and proportion meta-analysis of surgical strategies and outcomes

Background: Intracranial hydatid cysts represent a rare manifestation of echinococcal disease, accounting for a small fraction of central nervous system involvement but often presenting with substantial mass effect and neurological compromise. Despite numerous case series, comprehensive synthesis of their clinical, radiological, and surgical characteristics remains limited. Methods: A systematic search was conducted across major electronic databases to identify studies reporting clinical, radiological, operative, and outcome data on intracranial hydatid cysts. Twenty-six studies met the inclusion criteria. Extracted variables were summarized descriptively, and patient-weighted crude estimates were calculated when numerical data were available. One-arm random-effects meta-analyses were performed for key postoperative outcomes, including recurrence, rupture, mortality, gross total resection, and complications. Results: The included studies encompassed a pooled cohort of 1,074 patients. Symptoms of raised intracranial pressure and focal neurological deficits were the most frequently reported clinical features. Radiological characteristics were largely uniform across studies, with well-defined, non-enhancing cystic lesions and associated mass effect documented in nearly all cases. Patient-weighted crude estimates indicated a broad age distribution, moderate rates of systemic echinococcosis, and variable follow-up duration. Meta-analytic modeling yielded pooled postoperative proportions of 0.14 for recurrence, 0.14 for rupture, 0.09 for mortality, 0.11 for gross total resection, and 0.22 for complications, with heterogeneity ranging from minimal to moderate depending on the outcome. Surgical management predominantly involved craniotomy with controlled hydrodissection or variations of the Dowling technique. Conclusion: Intracranial hydatid cysts continue to present substantial diagnostic and operative challenges. The pooled evidence demonstrates consistent radiological features, measurable risks of rupture and recurrence, and moderate postoperative morbidity despite adherence to established surgical principles. Early recognition, careful operative planning, and standardized reporting of outcomes are essential for refining management strategies and improving prognostic understanding of this uncommon condition.