Presentation
Painfull swelling in the right temporal fossa, with a history of hepatic hydatid cyst excision 5 years ago.
Patient Data
Non contrast CT shows:
well-defined septated cystic lesion is located in the right temporal area composed of three components, intracranial extradural, intraosseous, and extracranial sub-periosteal
the intracranial component is extradural and exerts mass effects on the right temporal lobe and the temporal and frontal horns of the right lateral ventricle, and causes a mild midline shift, without causing brain edema
the extracranial component is sub-periosteal, and causes dissection of the temporal muscle and ballooning in the right temporal fossa
both components are connected to each other through bony defects and containing some small cyst-like lesions
the wall of the lesions is hyperdense and the content is of CSF density, suggesting a hydatid cyst with daughter cysts
the lesion impacts the temporal bone and causes loss of the bone density and some bony remodeling and defects, allowing the both components to be connected, a small area of the temporal bone is thickened and hypodense indicating that the lesion was initially intraosseous
Laminated membrane, daughter cysts with protoscolices, bone tissue with inflammatory/granulomatous reaction, and foreign body type giant cells.
Case Discussion
The patient underwent surgery (excision of the lesion and the affected bone), and the lesion was easily resected from the dura, which was intact and was not opened.
The patient did very well after the surgery and was treated with albendazole for three months to reduce the risk of recurrence.
Cranial bone involvement is extremely rare, however many surgical points should be taken into consideration, such as excision of the entire affected bone to reduce the risk of recurrence, and in case of the cranioplasty, it might be better to be done later when the recurrence risk is significantly dropped.
Thanks to:
Dr. Tamer Alameer, Neurosurgery Department, Al Assad University Hospital, Damascus University, Damascus, Syrian Arab Republic
Dr. Alia Alaitouni, Pathology Department, Al Assad University Hospital, Damascus University, Damascus, Syrian Arab Republic
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