AHMET SALDUZ, Lütfü Özgür KOYUNCU, Fatih DİKİCİ, Ufuk TALU

Paraspinal ve ekstradural yerleşimli spinal kist hidatik tedavisinde uzun dönem takip sonucu: Olgu sunumu

Kist hidatik, değişik organları tutabilen, tanı ve tedavisi zor bir zoonozdur. Primer kemik tutulumu olguların %2’sinde gözlenir. Kemik tutulumu olan olguların yaklaşık yarısında ise omurga tutulumu vardır. Kırk biryaşında kadın hasta, bacağa vuran kalça ağrısı yakınmasıyla başvurdu. Fizik muayene, radyolojik ve laboratuvar incelemeleri sonucu intraspinal ekstradural, vertebral ve paravertebral tutulumlu spinal kist hidatik tanısı kondu. Ameliyat öncesi ve sonrası dönemde antihelmintik tedavi uygulanan hastaya iki aşamalı posterior ve anterior cerrahiyle medikal eksizyon uygulandı. Hastanın 5.5 yıllık izleminde nüks saptanmadı. Nüks oranlarını azaltmak için antihelmintik tedaviye cerrahi öncesinde başlamak, cerrahi sırasında kist içine skolisidal madde enjekte etmek ve komşu dokulara yayılımı önleyici cerrahi prensiplere özen göstermek gerekir.

Anahtar Kelimeler:

Erişkin, Ekinokokkoz, Epidural alan, Kadın, Manyetik rezonans görüntüleme, Tomografi, x-ışınlı bilgisayarlı, Omurilik hastalıkları

Long-term result of treatment for paraspinal and extradural hydatid cyst: A case report

Hydatid cyst is a zoonosis affecting any part of the body and presenting difﬁculty in diagnosis and treatment. Primary bone involvement seen in about 2% of the cases is accompanied by spinal involvement in 50%. A 41-year-old female presented with low back pain radiating to the left leg. After physical examination, radiologic and laboratory investigations, a diagnosis of spinal hydatid cyst was made with intraspinal extradural, vertebral, and paravertebral involvement. The patient was treated with two-staged posterior and anterior surgical resections with addition of pre-and postoperative antihelminthic therapy. No recurrences developed within a follow-up of 5.5 years. Recurrences can be reduced by initiation of antihelminthic therapy preoperatively, perioperative injection of scolicidal agents into the cyst, and careful excision of the cyst without spread to neighboring tissues.

Keywords:

Adult, Echinococcosis, Epidural Space, Female, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Spinal Diseases,

___

1. Sapkas GS, Machinis TG, Chloros GD, Fountas KN, Themistocleous GS, Vrettakos G. Spinal hydatid disease, a rare but existent pathological entity: case report and review of the literature. South Med J 2006;99:178-83.
2. Onbas O, Kantarcı M, Alper F, Sekmenli N, Okur A. Spinal widespread intradural extramedullary hydatidosis. Neuroradiology 2004;46:310-2.
3. King CH. Cestodes. In: Mandell GL, Bennett JE, Dolin R. editors. Douglas and Bennett’s principles and practice of infectious diseases. 5th ed. Philadelphia: Churchill Livingstone, 2000. p. 2962-3.
4. Özdemir HM, Ogün TC, Taşbaş B. A lasting solution is hard to achieve in primary hydatid disease of the spine: long-term results and an overview. Spine 2004;29:932-7.
5. Herrera A, Martínez AA, Rodríguez J. Spinal hydatidosis. Spine 2005;30:2439-44.
6. Govender TS, Aslam M, Parbhoo A, Corr P. Hydatid dis- ease of the spine. A long-term followup after surgical treatment. Clin Orthop Relat Res 2000;(378):143-7.
7. Karadereler S, Orakdöğen M, Kılıç K, Özdoğan C. Primary spinal extradural hydatid cyst in a child: case report and review of the literature. Eur Spine J 2002;11:500-3.
8. Baysefer A, Gönül E, Canakçı Z, Erdoğan E, Aydoğan N, Kayalı H. Hydatid disease of the spine. Spinal Cord 1996; 34:297-300.
9. Turgut M. Hydatid disease of the spine: a survey study from Turkey. Infection 1997;25:221-6.
10. Işlekel S, Zileli M, Erşahin Y. Intradural spinal hydatid cysts. Eur Spine J 1998;7:162-4.
11. Braithwaite PA, Lees RF. Vertebral hydatid disease: radiological assessment. Radiology 1981;140:763-6.
12. Karray S, Zlitni M, Fowles JV, Zouari O, Slimane N, Kassab MT, et al. Vertebral hydatidosis and paraplegia. J Bone Joint Surg [Br] 1990;72:84-8.
13. Sjölander A, Guisantes JA, Torres-Rodriguez JM, Schröder H. The diagnosis of human hydatidosis by measurement of specific IgE antibody by enzyme immunoassay. Scand J Infect Dis 1989;21:213-8.
14. Booz MK. The management of hydatid disease of bone and joint. J Bone Joint Surg [Br] 1972;54:698-709.
15. Seçer HI, Anık I, Çelik E, Daneyemez MK, Gönül E. Spinal hydatid cyst mimicking arachnoid cyst on magnetic resonance imaging. J Spinal Cord Med 2008;31:106-8.
16. Arazi M, Memik R, Kapıcıoğlu MI. Answer please. Hydatid disease of the spine. Orthopedics 1998;21:912.
17. Szypryt EP, Morris DL, Mulholland RC. Combined chemotherapy and surgery for hydatid bone disease. J Bone Joint Surg [Br] 1987;69:141-4.
18. Yıldız Y, Bayrakçı K, Altay M, Sağlık Y. The use of polymethylmethacrylate in the management of hydatid disease of bone. J Bone Joint Surg [Br] 2001;83:1005-8.
19. Kayaalp C, Balkan M, Aydın C, Özgürtaş T, Tanyüksel M, Kırımlıoğlu V, et al. Hypertonic saline in hydatid disease. World J Surg 2001;25:975-9.
20. Kumar R, Lerski RA, Gandy S, Clift BA, Abboud RJ. Safety of orthopedic implants in magnetic resonance imaging: an experimental verification. J Orthop Res 2006;24:1799-802.
21. Harkess JW, Daniels AU. Introduction and overview. In: Canale ST, editor. Campbell’s operative orthopaedics. Vol. 1, 10th ed. Philadelphia: Mosby; 2003. p. 223-42.
22. Arif SH, Shams-Ul-Bari, Wani NA, Zargar SA, Wani MA, Tabassum R, et al. Albendazole as an adjuvant to the standard surgical management of hydatid cyst liver. Int J Surg 2008;6:448-51.