PMC5154201_01
Axial brain CT without contrast showing a well-defined, CSF dense, solitary, cystic lesion located in the right parieto-occipital region. The lesion is causing mild mass effect on the midline which appears slightly shifted to the left. Cortical sulci are effaced in the right hemisphere and minor compression of the posterior body of the right lateral ventricle is evident. No focal calcifications, septations, or daughter cysts are evident in the lesion
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F1
Axial brain computed tomography (CT) [Figure 1] showed a single intracranial cyst, located at the right parieto-occipital region, measuring 45 x 48 mm, and causing mass effect on the surrounding structures.
(a) T1W brain MRI without contrast shows an oval-shaped, intra-axial, cystic lesion at the right parietoocipital region. Mild hypointensity within the adjacent brain parenchyma can be detected in the parasagittal occipital lobe, which suggests the presence of vasogenic edema or inflammatory process. There is no apparent soft tissue component. (b) T1W brain MRI with contrast shows a linear, mural enhancement on the medial aspect of the cysts parasagittal border suggesting an inflammatory process
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F2
Axial magnetic resonance imaging (MRI) [Figures 2 and 3a] revealed the presence of a single large, well-defined, oval-shaped intra-axial cystic lesion, located at the right parieto-occipital region, measuring 45 x 50 mm, with a linear enhancing component at its medial aspect.
(a) T2W brain MRI showing a CSF-intense cystic lesion in the right parieto-ocipital region. (b) Diffuse-weighted image (DWI) shows an intra-axial supratentorial parieto-occipital lesion with no evidence of restricted diffusion, thus ruling out the possibility that it might be an abscess
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F3
Axial magnetic resonance imaging (MRI) [Figures 2 and 3a] revealed the presence of a single large, well-defined, oval-shaped intra-axial cystic lesion, located at the right parieto-occipital region, measuring 45 x 50 mm, with a linear enhancing component at its medial aspect. Diffused-weighted image (DWI), however, showed an intra-axial parieto-occipital lesion with no evidence of restricted diffusion [Figure 3b].
Patient in a supine position with the head held in a 45  flexed position using the Mayfield frame. This position helped in the delivery of the cyst by enabling the cyst to be gravity-dependent
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F4
The patient was placed in the supine position and the head was held in a 45  flexed position using the Mayfield frame [Figure 4].
(a) Appearance of the hydatid cyst during removal by the Dowling-Orlando technique of hydrodissection. Injection of hypertonic saline dissected the cyst from the surrounding brain tissue, allowing the cyst to move outside of the brain. (b) Gross appearance of the hydatid cyst after intact removal
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F5
With continuous irrigation, the cyst was delivered successfully without rupture in our case [Figure 5].
(a) Postoperative T2W axial brain MRI showing a small cystic cavity at the location of the excised cyst. (b) Postoperative brain CT without contrast documents the complete excision of the hydatid cyst and shows some postoperative changes such as pneumocephaly. There is no mass effect or midline shift
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F6
Postoperative brain imaging documented the complete excision of the cyst and showed a small cystic cavity at the location of the excised cyst [Figure 6].
HE light microscopic vision shows an intact cyst, with a cyst wall composed of an outer laminated layer and an inner germinal cell layer with attached cysts containing scolices
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F7
Microscopically, sections show a cyst wall composed of a laminated outer layer and an inner germinal cell layer with attached cysts containing scolices [Figure 7].