Cerebral Echinococcosis in Children: Diagnostic Challenges and Treatment Strategies

Abstract Hydatid cyst is an endemic zoonotic disease caused by the larval stage of Echinococcus species, with transmission occurring through parasite eggs from domestic or wild animals. Although hepatic involvement is most common in children, intracerebral localization is rare and may pose serious diagnostic and therapeutic challenges. This study aimed to evaluate the clinical presentation, diagnostic workup, treatment strategies, and outcomes of pediatric patients with intracerebral hydatid cysts. We retrospectively analyzed 13 pediatric patients diagnosed with intracerebral hydatid cysts and followed in our tertiary care center between 2012 and 2025. Demographic, clinical, laboratory, radiological, treatment, and follow-up data were reviewed. The mean age was 8 years, with a male-to-female ratio of 1.1. Headache was the most common presenting symptom (69.2%). Six patients (46.2%) had concomitant involvement of other organs, most frequently the liver. Serological positivity was detected only in patients with hepatic involvement; all isolated cerebral cases were seronegative. All patients underwent surgical treatment. Albendazole was administered in all cases, and praziquantel was added in two resistant cases. Recurrence occurred in one patient. No mortality was observed. Cerebral echinococcosis should be considered in the differential diagnosis of pediatric patients with unexplained intracranial mass lesions, particularly in endemic areas. Seronegativity does not exclude diagnosis in isolated cerebral disease. Comprehensive imaging and surgical excision remain the cornerstone of management, supported by antiparasitic therapy in select cases.