Abstract
INTRODUCTION AND IMPORTANCE: Hydatidosis is a cosmopolitan zoonosis caused by larval stages of Echinococcus granulosus. The brain is a rare location for this disease to occur, especially in adults. The occipital location is extremely unusual and the cysts are usually solitary. Cerebral hydatid cysts may be primary or secondary. Primary multiple bilateral cerebral hydatid cysts are extremely uncommon. This case aims to highlight the diagnostic process and surgical management of primary bilateral hydatid cysts. CASE PRESENTATION: We present the case of a 36-year-old Tunisian man admitted to our institution for headache and visual impairments. Neurological examination revealed bilateral decreased visual acuity. Cranial MRI showed two primary bilateral occipital hydatid cysts. The patient underwent successful surgical excision using two craniotomies in a single procedure. CLINICAL DISCUSSION: Primary multiple bilateral cerebral hydatid cysts are extremely rare. The pathogenetic mechanisms of this entity are not yet precisely known. Clinical symptoms vary depending on the location of the cysts in the brain. Several diagnostic methods can be used, computed tomography and especially magnetic resonance imaging, which represent the gold standard in the diagnosis of multiple and bilateral cerebral hydatid cysts. The treatment of primary multiple hydatid cysts is exclusively surgical. The key to an optimal result is careful surgical technique that avoids preoperative ruptures and complications. CONCLUSION: Primary multiple cerebral hydatidosis is extremely rare, even in endemic areas. Diagnosis is by imaging techniques and treatment is primarily surgical. With a careful surgical strategy and appropriate postoperative management, patients can recover without neurological sequelae.