Cerebral hydatidosis in children from an endemic region: Epidemiology, diagnosis, and management

Background: Cerebral hydatidosis is a rare parasitic disease caused by Echinococcus granulosus . While it most commonly affects the liver and lungs, cerebral involvement occurs in only 1–2% of cases. Pediatric patients from endemic Andean regions represent the population most commonly affected. Methods: We present a case series of 10 pediatric patients diagnosed with cerebral hydatid disease and treated at Instituto Nacional de Salud del Niño – Breña and Hospital Nacional Guillermo Almenara Irigoyen in Peru. We performed a descriptive analysis encompassing epidemiological, clinical, radiological, surgical, and pathological features. Results: Patients ranged from 3 to 14 years old, with 7 males and 3 females. Nine patients originated from endemic highland regions. Headache was present in all patients, vomiting in six patients, and motor deficits in six patients. Neuroimaging revealed large, well-defined cystic lesions without perilesional edema, mostly located in the cerebral hemispheres. Serological testing was positive in three patients. Complete intact cyst excision was achieved in all patients in whom microsurgical dissection was combined with the Dowling–Orlando technique, whereas the only intraoperative rupture occurred in the case operated without microsurgical assistance. Histopathology confirmed Echinococcus granulosus in all patients. Two patients presented with hydrocephalus and required ventriculoperitoneal shunt placement in addition to cyst removal. Conclusion: Cerebral hydatidosis must be considered in children from endemic regions presenting with cystic brain lesions. Early diagnosis and complete surgical removal remain the cornerstone of management. The combined use of the Dowling–Orlando technique with meticulous microsurgical principles is essential to achieve safe and successful excision, particularly in large or complex cysts.