Turkish Neurosurgery 2009 , Vol 19 , Num 4
Combined Anterior and Posterior Approach for Sacral/Retroperitoneal Hydatid Cyst Disease: Case Report
1,4Kahramanmaraş Sütcü İmam University, Medical Faculty, Neurosurgery Department, Kahramanmaras, Turkey
2Kahramanmaraş Sütcü İmam University, Medical Faculty, General Surgery Department, Kahramanmaras, Turkey
3Kahramanmaraş Sütcü İmam University, Medical Faculty, Radiology Department, Kahramanmaras, Turkey
5Kahramanmaraş Sütcü İmam University, Medical Faculty, Family Medicine Department, Kahramanmaras, Turkey
Achieving complete resolution of spinal hydatid cyst disease is quite challenging when bone is involved. Many authors reported the poor outcome of posterior decompression and laminectomy for intraosseous spinal hydatid disease. In an attempt to avoid a similar poor outcome, hydatid cysts were reached via both anterior and posterior surgical approaches in our patient. A 73-year-old man presented with complaints of low back and right leg pain. Symptoms or signs of systemic hydatid cyst disease were absent. MRI demonstrated a cystic lesion in the presacral/retroperitoneal region, involving the body of the sacrum and sacral canal. Computed tomography images showed enlargement of the sacral foraminae. The multiseptated cysts and their contents were isodense with cerebrospinal fluid. The cysts were removed via an anterior extraperitoneal approach, using a paramedian vertical incision, and then were also approached posteriorly via bilateral S1 hemilaminectomy. No neurological deficits occurred following surgery. The patient's symptoms completely disappeared after this combination of aggressive surgery and antihelminthic therapy. The application of both anterior and posterior approaches to intraosseous sacral hydatid cysts may be preferred when faced with hydatid disease in this location. Keywords : Anterior extraperitoneal approach, Retroperitoneal region, Sacral hydatid cyst
Corresponding author : Mehmet Senoglu, mehmetsenoglu@hotmail.com