Case report: isolated central nervous system involvement in pediatric cystic hydatid disease managed with TIVA and neuromonitoring

Cystic echinococcosis (CE) of the central nervous system (CNS) is a rare parasitic disease, particularly challenging in pediatric populations. While endemic in certain regions, its global epidemiology is shifting due to migration, leading to increased incidence in non-endemic areas. This case report presents a unique instance of a giant, isolated CNS hydatid cyst in a child from an endemic region, emphasizing the critical role of multidisciplinary management and the broader implications of disease migration. We report the case of an 8-year-old girl from an endemic region presenting with progressive facial paralysis and severe headache. Neuroimaging revealed a large hydatid cyst (61.8 × 61.5 mm) in the left parietal lobe, causing significant midline shift. The patient underwent successful surgical excision under total intravenous anesthesia (TIVA) with continuous intraoperative neuromonitoring (IONM). The postoperative course was uneventful, with complete resolution of symptoms and no neurological sequelae. This case highlights the successful management of a rare pediatric CNS hydatid cyst in an endemic setting, demonstrating the efficacy of a tailored neurosurgical and neuroanesthetic approach. It underscores the importance of considering CE in the differential diagnosis of cystic brain lesions globally, especially in light of changing migration patterns that bring this disease to new geographic areas. Increased awareness and robust healthcare systems are crucial for timely diagnosis and optimal outcomes in this evolving epidemiological landscape.