Cerebellar hydatid cyst in an elderly woman: Case report and literature review

Background: Intracranial hydatid disease is an uncommon manifestation of cystic echinococcosis, accounting for only a small proportion of all cases of hydatid disease. Cerebellar involvement is exceptionally rare, with most reported cases occurring in pediatric patients and involving the supratentorial compartment. Consequently, cerebellar hydatid cysts represent a diagnostic challenge because their clinical and radiological features overlap with those of other cystic lesions of the posterior fossa. Case Description: A 68-year-old female presented with a several-month history of progressively worsening pulsatile headache, nausea, vomiting, vertigo, visual symptoms, and gait instability. Neurological examination revealed gait ataxia with right-sided lateralization. Magnetic resonance imaging demonstrated a well-circumscribed multilobulated cystic lesion within the right cerebellar hemisphere measuring approximately 19 × 31 × 18 mm, characterized by thin internal septations and mild peripheral enhancement without an identifiable mural nodule. The radiological differential diagnosis included neoplastic, infectious, and parasitic lesions of the posterior fossa. The patient underwent suboccipital craniectomy with gross-total microsurgical excision of the lesion without intraoperative rupture of the cyst capsule. Histopathological examination demonstrated a laminated acellular cyst wall containing multiple protoscolices and refractile hooklets, confirming the diagnosis of hydatid cyst (cystic echinococcosis). Postoperative imaging confirmed complete lesion removal without hemorrhagic or hydrocephalic complications. The patient experienced progressive neurological improvement and was discharged in stable condition. Conclusion: Cerebellar hydatid cysts are exceptionally rare lesions that should be considered in the differential diagnosis of cystic posterior fossa masses, particularly in endemic regions. Histopathological confirmation remains essential for definitive diagnosis, whereas complete surgical excision without cyst rupture remains the cornerstone of treatment. The advanced age of our patient further emphasizes the unusual nature of this presentation.