Primary hydatid cyst of sacral spinal canal: Case report

OBJECTIVE AND IMPORTANCE: Primary hydatid cysts of the spinal canal are very rare. The patient in the present case presented with lower cauda equina compression caused by a primary solitary hydatid cyst of the sacral spinal canal, which is a remote possibility. To the best of our knowledge, such a case has not been reported previously. CLINICAL PRESENTATION: A 15-year-old male patient presented with lower motor neurone type of bladder and bowel involvement, with saddle-shaped anesthesia involving S2-S5 dermatomes. Plain x-rays and magnetic resonance imaging (MRI) scans revealed a widened sacral canal with pressure changes. MRI scans confirmed the cystic nature of the lesion, which had no specific characteristics and demonstrated intensities that were similar to those of cerebrospinal fluid. TECHNIQUE: Surgical exploration of the sacral canal with enucleation of the cyst in tote was performed. A midline posterior approach was used by decompressing thinned posterior elements. Adjuvant therapy with mebendazole or albendazole was not administered, although recently, some authors claim good results with integrated surgical and medical treatment. CONCLUSION: The patient experienced dramatic improvement and became continent. At a follow-up examination after 1 year, he had only minimal urinary stress incontinence. If spinal hydatid cyst is surgically removed unruptured and other common primary sites are excluded, medical treatment can be deferred, provided the patient undergoes strict follow-up. MRI, although not specific for hydatid disease, should be the investigation of choice in suspected cases of spinal hydatid cyst.