A new surgical technique for the removal of extensive spinal epidural hydatid cyst

BACKGROUND: Extensive spinal epidural hydatidosis may contribute to extensive spinal cord compression. Multilevel laminectomy with surgical excision remains the gold standard for treating these lesions which are typically invasive, and have a high recurrence rate. CASE DESCRIPTION: A 35-year-old female with recurrent extensive spinal epidural hydatid cysts was treated with a limited laminectomy and uniquely with irrigation-aspiration with isotonic saline water through an epidural catheter under fluoroscopic guidance and x-ray control. The postoperative MRI documented the hydatid cysts have collapsed and the patient's paraparesis improved. She developed no disease recurrence or renewed deficits over the next 12 months. CONCLUSION: Through a laminectomy, an epidural catheter may be introduced under fluoroscopic guidance/x-ray control to uniquely irrigate with isotonic saline/aspirate and decompress—the epidural hydatid cysts. This is particularly useful in patients with significant comorbidities, who are not candidates for more aggressive surgical decompression. Further, all patients should be continued on prolonged chemotherapy and should be monitored closely due to the high rate of recurrence of these cysts.