PMC4524006_01
(a) T1-weighted magnetic resonance imaging axial section demonstration multiple cysts generating a hypointense signal. Multiple septations can be appreciated significant mass effect can be appreciated. (b) T2-weighted magnetic resonance imaging axial section representing multiple cysts with a hyperintense signal and the cyst walls generating a hypointense signal. (c) T1-contrast enhanced magnetic resonance imaging axial cut showing contrast enhancement of the cyst wall in some regions. (d) Fluid attenuated inversion recovery sequence coronal section showing multiple cysts as hypointense signals and significant mass effect
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F1
A magnetic resonance imaging (MRI) brain was performed which showed multiple intracranial cysts predominantly in the right frontal region with significant mass effect [Figure 1].
(a) Intraoperative photograph demonstrating the durotomy incision and the capsule of a huge hydatid cyst. (b and c) Photograph of daughter/secondary cysts in the brain parenchyma after the first cyst was removed. (d) The main cyst and two daughter cysts after excision with intact capsules
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F2
There was significant dural tension, and a c-shaped durotomy was done which revealed a huge hydatid cyst extending toward the lateral ventricle [Figure 2a]. A soft rubber catheter was inserted between the brain parenchyma and the cyst capsule (Dowling's technique); a cleavage plane was established using warm hypertonic saline and the cyst was delivered unruptured [Figure 2d]. Numerous daughter cysts were then identified which were carefully delivered unruptured using the same technique [Figure 2b and c].